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Permit CITY TIGARD SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT # : SIT2001 -00004 DATE ISSUED : 10/26/01 - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 08770 SW SCOFFINS ST PARCEL : 2S102AA -02800 SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING : CBD BLOCK: LOT: 026 JURISDICTION : TIG CLASS OF WORK: PAVING ?: Y RESO. NO: TYPE OF USE: GRADING ?: Y VALUE: $75,000.00 EXCV VOLUME: cy LANDSCAPING ?: Y FILL VOLUME: cy SITE PREP ?: Y ENG FILL ?: STORM-DRAINS ?: Y SOILS RPT REQD ?: Y IMPERV SURFACE: sf Remarks: Site work permit for 12,000 square foot addition to existing building. Owner: FEES TUALATIN VALLEY MENTAL HEALTH 8770 SW SCOFFINS RD Type By Date Amount Receipt TIGARD, OR 97223 PLCK CTR 2/1/01 $394.91 27200100000 FIRE CTR 2/1/01 $243.02 27200100000 PRMT CTR 10/25/01 $607.55 27200100000 Phone: 503 - 617 -3827 5PCT CTR 10/25/01 $48.60 27200100000 Contractor: EROS CTR 10/25/01 $100.00 27200100000 PAR TECH CONSTRUCTION INC ERPU CTR 10/25/01 $26.00 27200100000 PO BOX 1899 ERPC CTR 10/25/01 $26.00 27200100000 CLACKAMAS, OR 97015 Total $1,446.08 Phone: 503 - 557 -8300 Reg #: LIC 109451 Required Inspections • Erosion Control Insp 846 -8444 Excavation Grading EXPIRED Paving Insp Landscaping Insp Final Report Eng'd Grading Final Inspection • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987: • / Permittee Signature: 2S, , Issued By: X4 / ? Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day I ' /1 si . I . Building-Permit Application Alk . Date received:2 -/ "0/ Permit no.:j r- )/ - "' r t City of Tigard " J g Project/appl. no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Phone: (503) 639 -4171 Date issued: By:. I Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: l&2 family: Simple Complex: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory yCommercial/industrial ❑ Multi- family New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION Job address: , 10 t.) COP fA.$ , - T Bldg. no.: Suite no.: Lot: S 2(o Block: Subdivision: -amizo Fht'ot�u ' j-Mot3 Tax map /tax lot/account no.: 251 - 024A Project name: - 02:00 Description and location of work on premises/special conditions: !Z OCO SF A'2D /Z[o#►/ To EXIST?. $ OW Sr . 0(4,6 OWNER FOR SPECIAL INFORMATION, USE CHECKLIST (Floodplain, septic capacity, solar, etc.) Mailing address: . - • • Co e(,._ - ► , 1& 2 family dwelling: 7 State: !t. ZIP: - 2 4 9 Valuation of work $ Phone: / Jin] Fax:6'0 - _• No. of bedrooms/baths Owner's representative: , A U _ — - L _ Total number of floors Phone: Fax: E-mail: New dwelling area (sq. f APPLICANT Garage/carport . sq. ft.) Name: ,,,,; A/*. Covered area (sq. ft.) Mailing address: 3 5u, /1l«47o PKwy Dec area (sq. ft.) , b '� f ► State: Q r ZIP: ' 72o/ Other structure area (sq. ft.) ____11. 6 rizzaaan. inmalim E -mail JWF279 eAoL•C . ' mmercial/mdustrial / multi- family: �� CONTRACTOR Valuation of work $ �: / d Business E (, Existing bldg. area (sq. ft.) usiness name: r i - Address: New bldg. area (sq. ft.) Z) O City: State: ZIP: Number of stories 2. Phone: Fax: Type of construction "Z N CCB no.: Occupancy group(s): Existing: Ri City/metro lie. no.: New: C Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under Name: -flt -iv (L *J 44 . • • re -r. provisions of ORS 701 and may be required to be licensed in the Address: 3223 jurisdiction Afro where work is being performed. If the applicant is �, ' .r State: og- ZIP: - 201 exempt from licensing, the following reason applies: Contact person: 4'f4 Nfitsof Plan no.: Phone: -0617 : •l lrmail II. — - `- - - - ENGINEER RIMZEIIM Contact person: i iQtivl Fees due upon application $ Address: P.,v, • Date received: al ZIP:. 03O Amount received $ Phone: / , - ' Z Fax:Gf, .QjZf' E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard work will be complied wi r he - r spec' herein or not. credit card number F s A signature: rl�r0• i. � Date: 2 / /O/ Name of cardholder as shown on credit card Expires Print name: Mire- ' D. ' We $ Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6R)0/COM) DT i r 1 SITE WORK PERMIT CHECK LIST Commercial and Multi - Family: Complete ENTIRE form. Residential: Complete SHADED areas only. • 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 "TAN" Plumbing Permit Application for site utilities plumbing work. Plans Required: See "Site Work Permit Application - Plan Submittal • Requirements" attached. The following mu st accompany this application: Site Plan with Vicinity Map Parking (including ADA) and showing ADA compliance Lighting Plan, Grading Plan and details • Landscaping Plan , Erosion Control Plan and details • Retaining Structures Site Utility Plan and details Soils Report (if required) (showing connection.to approved system) is \dsts \forms\sitecheddist.doc 12/21/00 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested ` ° I AM PM BUP Location 8 770 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ) SWR BUILDING Tenant/Owner / v ` i1/ t..V.41 ) &t1Z -ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT o2 0 7) i'able° Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL 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 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 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA <i l l /0 Approach/Sidewalk Date Inspector • Ext Other: DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL