Permit •
CITY OF TIGARD
SITE WORK PERMIT
API DEVELOPMENT SERVICES PERMIT # : SIT2002 -00037
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 1/27/03
SITE ADDRESS: 14800 SW SEQUOIA PKWY PARCEL : 2S112AD -00900
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SUBDIVISION: ZONING : I -P
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: N RESO. NO:
TYPE OF USE: COM GRADING ?: N VALUE: 108,000.00
EXCV VOLUME: 0 cy LANDSCAPING ?: N
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: Y IMPERV SURFACE: sf
Remarks: Site work for new 1445 square foot building addition for tool rental.
Owner:
FEES
HOME DEPOT USA INC
• 370 CORPORATE DRIVE Description Date Amount
TUKWILA, WA 98188 [BUILD] PrmtFee -Valu 12/13/02 $170.94
[BUPPLN] Pln Ck -Valu 12/13/02 $504.08
Phone: 1 -206- 574 -3567 [FLS] FLS Pln Rv 12/13/02 $310.20
[TAX] 8% St Tax -Valu 1/27/03 $62.04
Contractor: [ERPRMT] Erosion Cntl 1/27/03 $80.00
FERGUSON CONSTRUCTION [ERPLN] Ersn Plck-USA 1/27/03 $26.00
7433 5TH AVE. S. [EROSN] Ersn Pick -COT 1/27/03 $26.00
SEATTLE, WA 98108 [BUILD] Addl Permit 1/27/03 $604.56
Total $1,783.82
Phone: 206- 767 -3810
Reg #: LIC 91351
Required Inspections
Paving Insp
Misc. Inspection
Final Inspection
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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 dk:optesiby the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through R 952 -00 - 100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -669. �� ,• rr I
I
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ssue By: 4 C�lYd
Permittee Signature: I
Call (503) 639 -4175 by 7:00 - M. for an inspection needed the next business' day
i. • t � A)4 ,_/�
.•
Building Perm ` 1 t 1 on OFFICE USE ONLY
�dk i; City of Tigard BBC 3 Z0 D ate received: 42/� 9, Permit no.: ,6, p ,1_paC37
!irr "Y , Tom Project/appl. no.: ' e date:
City of Tigard Address: 13125 SW Hall Blvd, TigardaltseU�3TIGAMP
Phone: (503) 639 -4171 ®U ®IN p issued: B Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: M N.0Peo,91- coo 3I 1 &2 family: Simple Complex: f. _` - • . TYPE OF PERMIT
0 1 & 2 family dwelling or accessory w Commercial /industrial 0 Multi- family 0 New construction 0 Demolition
' Addition /alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
. - • JOB SITE INFORMATION .
Job address: 14 $pO S' c . Uv I • •". IL .„ ; • Bldg. no.: Suite no.:
Lot: q Block: Subdivision: Ti G - - . . 2 Tax map /tax lot/account no.: 2S , — bb,o•
Project name: ,■ __ .V�Z; 7 ri• :an l b►- 1 g ?. ebe pe°3 1
Description and location of work on premises /special conditions: _Ic e. ftb111 'fib G is 7 J-.1r 1
L:10 N1 12 ?c51 •
' +i : =OWNER . - - FOR SPECIAL INFORIIIATION, USE CHECKLIST
Name: uME • ,��oT _ s • IBC. - ..
(Floodplain, septic capacity, solar, etc.)
Mailing address:37p ��• - r _ .. ... w ► - ore_ 1 & 2 family dwelling:
City: 71.1 r,1,J1 • State: L1 A ZIP.9 81 $$ Valuation of work $
Phone:20, S • 35 EINTIMME E -mail: No. of bedrooms/baths
0 - ' - . - - . t ' - : !Lie_ se, Z q, Total number of floors
Phone: — : iii, e -,_ Fax: E -mail: New dwelling area (sq. ft.)
.i.,- ` ,, :.: ,: - •,` ,' ': - APPLICANT Garage /carport area (sq. ft.)
� , , , Covered porch area (sq. ft.)
Mailing address: Li, 0 (1(Q : G MJe • I I� - , Deck area (sq. ft.)
City: ,ek/1,t E OEM ZIP: - Bco i Other structure area (sq. ft.)
Phone: ,� , 23.6 3 1 Commercial/industrial /multi- family: •
-`4 CONTRACTOR Valuation of work $ 10 g ea° _
Existing bldg. area (sq. ft.) _
, Business name:
Address: New bldg. area (sq. ft.)
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City: State: ZIP: Number of stories ,_
Type of construction
Phone: Fax: E -mail:
CCB no.: Occupancy group(s): Existing: _
New: _
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: ! , e 1,4 _ ht • - provisions of ORS 701 and may be required to be licensed in the
Address: 2 ,-y 1 y � } B jw 1 Zbo jurisdiction where work is being performed. If the applicant is
exempt from licensing, the following reason applies:
City: $,( 4,0%7 . State: W/} ZIP: - :bp
C. • t. - . .\;:b IP .1,,,,1 �j Plan no.:
Phone:( 14t 4 - MEM trir E- mail:
ENGINEER OFFICE USE ONLY ';),
MM Contact person: r, Fees due upon application $
Address: • 5 U CL 4 �. u I1 ( be Date received: ,ii
EM t, State: be. ZIP: 9 Z Amount received $
Phone , f • 9 2 06 M • 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 0 Visa 0 MasterCard
work will be complied with w ether specified herein or not. Credit card number: I /
Expires
Authorized signature: Date: 10 1 IS I b L. Name of cardholder as shown on credit card
Print name: t t�E
[[ Cardholder signature Amount
X 11 (' o—C q,
Notice: This permit application expires if a permit is not obtained witlun 180 days after it has been accepted as complete. 440.4613 (6/00 /COM)
1
CITY OF TIGARD 24 -Ho
BUILDING Inspec ine: (503) 639 -4175
INSPECTION DIVISION Busines e: (503) 639 -4171 MST
• BUP 3.-000 7�
Received Date Reque d �— AM PM BUP
Location Suite MEC
Contact Person ,D –, 1 Ph ('O' ) o SS 3&5-3 PLM
Contractor Ph ( ) SWR
LDING Tenant/Owner ELC
Foundation ELC
Access: 4A4c STO.r-.
Ftg Drain ELR
Crawl Drain O
Slab Inspection Notes: SIT 9 (JO 37
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
F
_ ___ PART FAIL r ,
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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
SIT ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line c
ADA / /l
Date �) Inspector I Ext
Approach/Sidewalk
Other:
tom" DO NOT REMOVE this inspection record from the Job site.
`"ZWIIIII.- ART FAIL