Permit � � � ' ' G1 1 � �� SITE WORK PERMIT
CITY OF TIGA ,4,►I►
r4, DEVELOPMENT SERVICES PERMIT # : SIT1999 -00032
'" I ^13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED :. 8/3/99
SITE'`ADDRESS: 15340 SW ROYALTY PKWY PARCEL : 2S110CD -00102
W
SUBDIVISION: KING CITY NO. 2 ZONING :
BLOCK: LOT: 002 JURISDICTION : KIN
CLASS OF WORK: REP PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: $25,000.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Replace sidewalks - ADA upgrades.
Owner:
FEES
JOE MCCANN
15405 SW 116TH AVE Type By Date Amount Receipt
KING CITY, OR 97224 PLCK GEO 7/2/99 $110.83 • 99- 316408
MISC GEO 7/2/99 $68.20 99- 316408
PRMT DEB 8/3/99 $170.50 99- 317361
Phone: 5PCT DEB 8/3/99 $11.94 99- 317361
Contractor: EROS DEB 8/3/99 $80.00 99-317361
BNK CONSTRUCTION INC ERPU DEB 8/3/99 . $26.00 99- 317361
10730 SE HWY 212 ERPC DEB 8/3/99. $26.00 99- 317361
PO BOX 66 Total $493.47
CLACKAMAS, OR 97015
Phone: 557 -0866
Reg #: LIC 1075
Required Inspections •
Erosion Control Insp 844 -8444
Grading
Paving Insp
Landscaping 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- 0080.0 may obtain copies • ese rules or direct questions to OUNC by
• calling (503) 246 -1987. • // /
Permittee Signat • - . .
,
Issue. By: ; .4./
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
IW (0—Vi
CITY OF TIGARD Site Permit Application Recd By N`J
Date Recd G - G
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Date to P.E. '
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST '7 3.41 -
(503) 639 -4171 x304 Permit# V/r / fQp co 3.
Related SWR #
1 Called GTEdE V--//n/L— 74 ;fty
Print or Type '
Incomplete or illegible applications will not be accepted
Project Name
�,.� Utilities (Complete all that apply)
Job I' *T ,1304)11#-- ✓U4'
Address Address �,,� r� 7� Storm Sewer
l A5 1O Jv v f ��i/ f i�� d'1 Linear Ft.
Nam 6A piAI Sanitary Sewer
Owner Maiji = ` Fresh Water Linear Ft.
` 5 t �� ��� Linear Ft.
(416 GI tA 14122.4- Zip hone Catch Basins #
General Name , Clean Outs
Contractor i r) #
Prior to permit Mailing Address Describe work to be done:
issuance, a New A Q Q p Q
copy of all ❑ ddition Alteration Repair
licenses are City /State Zip Phone Additional Description of Work:
required if , � ``""
expired in COT State Const. Cont. Board Lic. # Exp. Date ��
database Pi/WAVES-
ES-
Name % Project
CE644,gg j' age G/ J i GAD • Valuation $ 7-5, 0
,Ascisitect M ilin Address Plans Required: See Matrix on back
G�l�lr(/9Dde—•41/f The following, must accompany this application:
City /State Zip Phone Site plan with Vicinity Map Parking (including
CDR47,47•11D ee- / �L4 Showing ADA compliance ADA) & Lighting Plan
• a;ngG /1, /0 Grading Plan and details Landscaping Plan
Engineer M • in Address ,r > Erosion Control Plan and Retaining Structures
3?, i 674,14 details including calculations
City/ tate Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
PO f 4124 I 2224107 approved d 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
cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill Volume Signature of Owner /Agent Date
(Soils report required for >5,000 cu. Yds.) �Q (V7------2-----. /�/+ A
KJ cu. yds. .& �l ' 1
Will the fill support a structure Contact Person Name Phone
(Engineer required if answer is yes) YESO NOD M 19
Retaining structure? (check one) QRock FOR OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
❑Other
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving ' Sq. Ft.
• .. 01 u 1ln .(63 t
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COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
?'1 n ew depaaden upon subntta clr BT plans Al aLETEU
a lication > Far a :: ::::.:.....:::: ..:...:.:.::., ' ::;.: . _.: ;...:::::.:.,.,:. .;..:,,.;..,.,;<:.:.<:...;':.:: ;::;.::.....::<...<..° < •:i <:: >» < > < >
::.: pp:.::.>:::;.::;;:::. :.::.::.::.::;;: >:.::::. »:<.:;� eleptrt+caI s�tl�rrtitta� the a ... it��tit�n r I�ntarn # h�ii::> i >:::::: >:: >:: >::::::.;::.::.:.
p to h.... r�ttsrn a e before pla . r view will be c nducted
::>; ::::::;;.:. <.::revtew appro l,. Plans Examiner wall cx ntact t a ....i nt to re uest:: >:: >:;::
..............:.......
KEY:
u ttted
m€
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
. :: ......::: .. :�. :� V. �� .: .�.,.. 1, 1333.:: ��::. :v:::. •.� �::.�::��v::: ��:.:::: ��:::.�.�:: �.
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NOTES:
ii'` <; ;<:::;::::;::'::;:::;::':::::<: i:::;:::;;::::::;:>' �:;::: i:;: ��<:>::::; �> �:;::::<.>.:<::: ��::>::::>::::>::::>::<::::::>::>::::>::::>::>::::> ?> �:»>::>:>::»:::::::>:>:<:::::>::::>::>::;:::; i< i:: i:: i:: i:: i>:;; >;i::i::i::i::i::i >::i::i:<::�:
I: \dsts \forms\matrxcom.doc 12/17/98
•
02/17/2000 Activities for Case #: SIT1999 -00032
•
2:50:22 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SITC005 Application received 06/25/1999 BON RECD No Hold GEO 07/02/1999
SITC008 Permit Created 07/02/1999 GEO DONE No Hold GEO 07/02/1999
SITC013 Plans Routed to Plans Examiner 07/02/1999 GEO SENT No Hold GEO 07/02/1999
SITCO26 Plans approved by CPE 07/13/1999 07/13/1999 07/13/1999 RDP DONE No Hold RDP 07/13/1999
SITC700 Erosion Control Insp 844 -8444 07/13/1999 07/13/1999 No Hold RDP 07/13/1999
SITCO30 Reviewed plans routed to DSTS 07/13/1999 RDP DONE No Hold RDP 07/13/1999
SITC720 Grading 07/13/1999 07/13/1999 No Hold RDP 07/13/1999
SITC730 Paving Insp 07/13/1999 07/13/1999 No Hold RDP 07/13/1999
SITC760 Landscaping Insp 07/13/1999 07/13/1999 No Hold RDP 07/13/1999
SITC799 Final Inspection 07/13/1999 07/13/1999 10/12/1999 GS FAIL No Hold JS • 10/13/1999 See BUP1999- 00277. 10/12/99.
SITCO32 DST Post - Review Completed 07/23/1999 DLH DONE No Hold DLH 07/23/1999
SITC080 (F) Ready to issue 07/23/1999 DLH DONE No Hold DLH 07/23/1999 Need contractor identified .
• before issuing permit.
SITC092 (F) Issue permit 08/03/1999 DEB DONE No Hold DEB 08/03/1999
SITC093 (F) Reprint Permit 08/26/1999 BON DONE No Hold BON 08/26/1999 •
SITA799 Final Inspection 10/20/1999 10/20/1999 10/15/1999 GS PASS No Hold JMT 10/20/1999
SITA800 Case Finaled 10/20/1999 JMT DONE No Hold JMT 10/20/1999
SITA800 Case Finaled 02/15/2000 JMT DONE No Hold JMT 02/15/2000 Plan sent to records
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -417 Business Line: 639 -4171
BUP
Date Requested /0 / AM / PM BLD
Location / 3 Y0 Se-e) aot4 t ?41 r 7 Suite MEC
Contact Person G ( Ph PLM
Contractor AAe� /�� Ph SWR
BUILDING Tenant/Owner iUeg - 6244, ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ' �/ ,mil
Sla 111._
j�i - o' SIT /9 '
Post & Beam Cez1 ���� U
Ext Sheath /Shear P ei
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
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
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
P SS PART FAIL
(S?
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 Q 7 �D
Approach /Sidewalk Date /D —� f 9 / Inspector _ ^� - Ext
Othe
.x,11 r
_ r b PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Buiness Line: 639 -4171 BUP 1 79'9 -0 Z77
Date Requested 10 Z"--19 � /�• A,M PM BLD
Location I Say �/�� C) 1 G / �e uite MEC 9c1-00,3/
Contact Person P S 313 -9 Sr) PLM
Contractor Ph SWR
JILDIR) Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT j ggq —aX 2
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear �
Framing ® 1 L �" .c, .� -
Insulation
Drywall Nailing .- 2 , /.A.rr- i .
Firewall
Fire Sprinkler - _
Fire Alarm
Susp'd Ceiling OP �.7�a..' /�,_ .���.- / • -__i
Roof I ,
Misc:
Fin ' / ,e'
PASS PART FA _.�� 1�/ , ., _.. . -4 • - _� ∎� - t
PLUMBING ?, 4 o
Post & Beam .
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL -
CHAN C
Post & Beam
Rough In
Gas Line
Smoke Dampers /
PASS - ART FAIL ./ ` ••''''
g O `. i �- W he -
ELECTRICAL
Service •$I k.' � __'c'J r • • ;•• -
Rough In •.--
UG /Slab - WA _�,.
Low Voltage
Fire Alarm
Final °� PASS PART FAIL /
�T�
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reins ection 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 7 Approach /Sidewalk Date /C /� - - ! Inspector . Ext
Other
PASS PART DO NOT REMOVE this inspection record from the job site.