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Permit ,a ` CITY TIGARD SITE WORK PERMIT i DEVELOPMENT SERVICES PERMIT # : SIT2004 -00004 '� 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 2/26/04 SITE ADDRESS: 13991 SW RIDGEFIELD LN PARCEL : 2S104DD 09700 SUBDIVISION: ELK HORN RIDGE ESTATES ZONING : R -7 BLOCK: LOT: 039 JURISDICTION : TIG CLASS OF WORK: OTR PAVING ?: RESO. NO: TYPE OF USE: SF GRADING ?: VALUE: 3,000.00 EXCV VOLUME: 120 cy LANDSCAPING ?: FILL VOLUME: 120 cy SITE PREP ?: ENG FILL ?: Y STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: Rockery wall. Owner: FEES PAUL R CARNEY Description Date Amount 1480 NW 102ND AVE PORTLAND, OR 97223 [BUILD] PrmtFee - Valu 2/26/04 $72.10 [TAX] Valu 8% State Sw 2/26/04 $5.77 Phone: 503 [BUPPLN] Phi Ck -Valu 2/26/04 $46.87 Contractor: Total $124.74 PAUL R CARNEY INC 1480 NW 102ND AVENUE PORTLAND, OR 97229 Phone: 503 - 297 -9406 Reg #: LIC 56852 Required Inspections Final Inspection (c_ 1 4.Qo /T 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- b.y,,,the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throug SOAR 952 - 001 -010e. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -66 9. a Iss d By: . �� Permittee Signature: )~ 1/ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day I) ; S ee,Work ., E V E tV E D 4, 00 ', : Building Permit Application , USE ONL City of and FEB 11 2004 Received �' TI g DateB s /t oi/ a Permit No.. �.•�s.,.�4: . 13125 SW Hall Blvd., Tigard, OR 9� Plan Revie A • ' 'O • • - ' Phone: 503.639.4171 Fax: 503.59P11936 OF TIGARD Nl�i 4 t r l IA\ Date /B : - /j" Other Permit. Inspection Line: 503.639.4175 BUILDING DIVISION, AT' II Date Ready /: : m? . O vow is` / ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method:_ , - j , 7 ' . Supplemental Information R . . - }, . . ' a.I , Y&l8�?^ : .,'w`- . �`.'i�iC � . {; F . f .n'$6. „� , z`��fi�$:x3ri� ;=rs rt : , � .;;�.� �.. •.a ", ; ,.,_ -, < - .:�� °' : �. t''' ; :., €=z `.� "l r; a;: I:'t r. -t,,( ; » I : '" �.,,. „ , ,. 0 t" = 'f`' .� -FAMIiff i , EL „ ' IN ' . i l: ', +.` :.Nti%I . ; t» . - cg , TYPE OFe W(?RKi2 .,,fit .'.' A ..` , W " .v 1;, .REQUIRED DATA 1 A ND 2 ":- .-',-. Y W.:... L' .G' ':fie ❑ 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 ',.•N. ,,x. =� e work indicated on this i i �,. ^� �. . a�s�'°��n,'�� �- ��>��.��., ;��;,., ,;4::;4 ^r;: „ �;�^:- :�,zu,�.., 50:,., =: ;�^', .f,�,��,: k d. application. . .� . x'.z ; - ` CATEGORY OFsCON5T7iUCTION ":'” ''4,9piir ct' 1 ., . Ow Valuation: $ t I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: `.a,ae::;,:t,*. ,,,,:, ,,QW —V'dnF '�n;,.:eta:ap ..x,T: 1,: PI '3 -f ',:, 9- +.'bi:, +t" ' r,x 1 ( F < , c ,% $ JOB SITE INFOR AND LO . - , ` ', ,,,,,,r,-,,,,,, i , n ,, Total number of floors: Job site address: 1 . 1i Ft, , New dwelling area: square feet City/State /ZlP: •J ( ,O ®g...— cl 'a -Z„`yL Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: L L , Z,0,46" CSM -r[ Covered porch area: square feet Cross street/directions to job site: �1 /z IELO v ` . Deck area: square feet Other structure area: square feet °'REQUIRED DATA COMMER USE C t ' Subdivision: El ... (� , , � �Syp'TeS Lot no.: 3 Permit fees* are based on the value of the work performed. ��F-� f'"` Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the ' , I g _,� , DESCRITPION OF WORKS ':. r work indicated on this application. p L Lv — a f'isi,ett7'9 Valuation: $ a { --ac -I t�Jirlt� �/!' I-� eAif S toe 1�1,)r 1;06 Ste+ c, L6T , s 6earez,N Existing building area: square feet New building area: square feet ® PROPERTY OWNER , . ^ ®- � s TENANT' - f _ i :, " t4 ? Number of stories: k �;It� a N 4- ,g':', . a =. ia'Ut.,,. _ i s,,. hiig »' tea. ,''sr z ±La -�_� _ Name: t 4- 1 (Ls 1.1..1b — ` - I Type of construction: Address: 1' b J).4 167_ Occupancy groups: r City/State/ZIP:. --, o n q---i 2 y 2 / Existing: Phone: (5 ) 931_ -7 Ls'S Fax: (Sh3) 5`f s - al 3 New: •'Ai - , i; ..: P4 NT � s4 M ? . t '::.. �r t�� ® .w CO , A ACT ERS r, , ' z; , :d w '., #� 4 ' � . ' � -" NOTICE Business name: S',, /mss 4 tzA✓er All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: y: Phone: ( ) Fax:: ( ) E -mail: . ^4;: "t' +`+ .v4v!:..i.: }: - '-'.k$3"tn.d, °+ ig,"e. .'!.#h ^'Ni i "'. •.3: ° =?z5 �ry .id. -: ,f. Ry =- -. R. Tic , ;VIW . > ' r CONTRAC,TOR . f l s x t i ..'V _.,.Y:,i An kit; "„._ d_ : �,,, Ve., s ikf401,^€ 6 -, , s _ . ,s n . , , 16VIP, t r �,.a ,., a - - ' Business name: `x; � : ; �' ;., � r, ._�: -. � : ,� .._. „ . �;' `> , : ,':'; � dk„1.x � a," .. . BU7I:D PERMIP .. ; '. Address: Please refer to fee schedule. City/State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lie.: 56 R 5-2-- A 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: Get' Date: 2J // jo * Fee methodology set by Tri- County Building Industry j / I el' Service Board. i:\Building\Permits\SIT- PermitApp.doc 12/03 440- 4613T(11/02/COM/WEB) 6 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: 120 cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) I Lb cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) 0-0 cu. yds. Retaining structure? (Check one) Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 0sq ft. 1a 14rH .. 01.«1 laESZta a_ tl`"'eagagC < .h��'��*"� lik._air ,_R 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 One- and Two - family dwellings. sy i ,.,� ,� �� �, ��� �� t� s °'` £ +�.�, i . n -w '�R �� A TY�PLOF SUBMI�TT'ALt. 'Requiredrat fr (I elud N ew,Additori5 orAlteratons) ; ." Subiiuttal, Commercial 2 Multi- Family R -1 Occupancy 2 One- & Two - Family Dwelling 2 i:\Building\Forms \SIT- Checklist.doc 12/29/03 CITY OF TIGARD 24 -Hour // BUILDING Inspection Line: (503) 639 -4175 MST `U��� INSPECTION DIVISION Business Line: (503) 639 -4171 BUP • Received Date Requested a AM PM BUP / Location ( . /•' Suite MEC Contact Person ��/t .C.o / ( ) �f � °j 7� S PLM Contractor h ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain . ELR Crawl Drain _ t _ �66�© Slab Inspection Notes: SIT at�G Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear i --- - Framing 6 � 4 Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Kay /tom FL-U N'► 6 bk../ o Ot r: _ na PASS PART t1 I I _ t n ! t`-� 1- ��/ Pr ''PLUMBING 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 Ai Dampers P ASS PART ,AIL E.CI a L :. Service Rough -In • UG /Slab Low Voltage , Fir- A arm 4OP PART FAIL ' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. E.'r : ` Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Z_ Approach /Sidewalk Date / Inspector Ext Other: �r DO NOT REMOVE this inspection record fro the job site. . 417 PART FAIL