Permit CITY TIGARD * SITE WORK PERMIT
� • DEVELOPMENT SERVICES PERMIT # : SIT2000 -00050
L � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 11/22/00
mss
SITE ADDRESS: 08500 SW SPRUCE ST PARCEL : 1 S136CB -04400
SUBDIVISION: ZONING : R -7
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $15,000.00
EXCV VOLUME: 28 cy LANDSCAPING ?: Y
FILL VOLUME: 28 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 1.615 sf
Remarks: Site work for placement of modular classroom
Owner:
FEES
JAPANESE INTERNATIONAL BAPTIST
8500 SW SPRUCE ST Type By Date Amount Receipt
TIGARD, OR 97223 . PLCK CTR 10/24/00 $121.75 27200000000
FIRE CTR 10/24/00 $74.92 27200000000
PRMT CTR 11/22/00 $187.30 27200000000
Phone: 503 - 246 -4680 5PCT CTR 11/22/00 $14.98 27200000000
•
Contractor: QUL% CTR 11/22/00 $275.00 27200000000
BILLS QUALITY CONSTUCTION WQUN CTR 11/22/00 $275.00 27200000000
EROS CTR 11/22/00 $80.00 27200000000
PO BOX 3035 ERPU CTR 11/22/00 $26.00 27200000000
NEWBERG, OR 97132 ERPC CTR 11/22/00 $26.00 27200000000
Phone: 503 - 550 -7744 Total $1,080.95
Reg #: LIC 123980
Required Inspections
Erosion Control Insp 846 -8444
Paving Insp
Strm Drain Insp
San Sewer 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. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
. Permittee Signature: /;y�
Issued By:
1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
diaLefi',..1t_, ,),,. , ../ A. _
Building Permit Appli c iiiiineP
phone: (503) 639 -4171 ion
Date received: / /'Z y/� Permit no.: sir�� O ws
City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Pro Ex pire date:
.ryo fTigard Date issued: By I Receiptno.:
Fax:
(503) 598 -1960 � u /° 2 �
( ) C ase file no.: Payment type:
Land use approval: �'"{ �`'�� ` I &2 fatuity: Simple Complex:
TYPE OF PERMIT
4,1 & 2 family dwelling or accessory 'Nit ❑ Multi- family ❑ New construction 0 Demolition
I. Addition/alteration /replacement ❑ Tenant improvement O Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: (-/ EJ .■\ _ )( � ' Bldg. no.: Suite no.:
Lot: Block: (Subdivision: T_ - -(,* (j(i (40 C) I Tax map /tax lot/account no.: , (p G
Project name: - '` is " - 1. - It, J I G 1 11 I 1 lot ♦ _ ; ' . t _ i ■. A a.■ CO
Description and location of work on premises/special conditions: 1 I)S1ti.i,P 1) X1.1 ¶ (�"r7F, C) Mv00 (L.
ukfrr F ( (� (Lciot -& V SAGri
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: a , iiNte,(h, P�44vrt' c, 7/--- V.( Floodplain , septic capacity, solar, etc.) - " ..
Mailing address: S 00 S w - -.;P(UC.{ G tr - 1 & 2 family dwelling:
City: 'r 4c 4,(c , I State: Or IZIP: Oil (7,7..3 Valuation of work $
Phone: EA, t.q(A.14.,91 :e('}"i.c4 t ?.y I E -mail: No. of bedrooms/baths
Owner's representative: kl\ t K() 140 KO t.\ Total number of floors
Phone: 2 - ( Fax: l: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.)
Name: „'
i Q � V Covered porch area (sq. ft.)
t ` ' � Deck area (sq. ft.)
Mailing address: 6i-C72 13 . ) \O.a Other structure area (sq. ft.)
City: (\ 9.,,.. -) f 2r. I State:Q,, I ZIP: q 11
Phone:5 03 - Fax: 5 mails' Commercial/industrial /multi - family: (S
SJ�i ' .i 'J 2, � , ►,
CONTRACTOR Valuation of work rAftegigir
Business name: Existing bldg. area (sq. ft.) to CJ 1 20
Address: - / New bldg. area (sq. ft.) l 9 7
City: I State: I ZIP: Number of stories 1
Phone: I Fax: I E -mail: Type of construction
CCB no.: Occupancy group(s): Existing: V-- I
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Boaid under
Name: E,R.,-n u, [tla0 inc. - AciiN ,Le c provisions of ORS 701 and may be required to be licensed in the
Address: cd.) _, M , Q .,� �/� ► jurisdiction where work is being performed. If the applicant is
City: �9••tjJ b 7 I State:Or I ZIP: ,11-/ ((L exempt from licensing, the following reason applies:
Contact person: l 1 Plan no.: 5-7 1 00
Phone: '1 , e1 14D Fax: _m a-7 kma i
Name: tri, p,,r.F -U .V{yj -7, Contact person: '4 , due upon application $ /96, , 6 7
Address: 47 a 6 k o Date received:
� 4
City: 1�' Le, IState:CN (ZIP:. 1'� —' Amount received $
_PhoneO E' .7 4 t. cl , Fax: •-- I 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 0 MasterCard
work will be compli. • - • • whe er ecifed her j in or n t. Credit card number. E x ur
V P
Authorized si : • re: //. .11 � tll Date: 0 U Name of cardholder as shown oo credit card $
Print name: il �
tag Cardholder signature nmouat
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (cc OM)
� ✓. � - E a % 1 � � y v is /, 75 u�i 0 . 1s
( "' I kt ,..k i 79 . 9.2 ,.1._ S
SITE 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) U.P ❑ Rock
❑ CMU
❑ Concrete
❑ Other
Total new impervious area including all buildings,
sidewalks, and paving: 1, )� I`� sq. ft.
Utilities (Complete all that apply)
Storm Sewer: p- {,;1(\, ns(_ 17).t,7c15 Linear Ft. I ?70
Sanitary Sewer: ' MQ, ID ,� Linear Ft. 00
Fresh Water: II 4 J J Linear Ft. l �'
Catch Basins: 0/ #
Clean Outs: # '�
Plans Required: See "Application /Plans Submittal Requirements" attached.
The following must accompany this application: V--3.
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 appr9ved
system)
is \dsts \forms\sitechecklist.doc 10/05/00
.G. rY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 ��
BUP� -
Date Requested l v AM PM BLD
Location I �� D 52 rpt. 9t Suite f
Contact Person Ad 6 Ph 3 / 3 a 7f/9 __
Contractor Ph
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: 4
Foundation FPS
Ftg Drain
Slab
Crawl Drain Inspection Notes: /`� / CV SGN y t �
frait
Post & Beam T
Ext Sheath /Shear 2 eft tC S�
Int Sheath /Shear ,, r
Framing S �ii.vw � iGZ -- r
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
BI
Post & Beam
Under Slab
To •
.46 er Servi
'filEMfa^ca.
Rain Drains p F '
ASS PART FAIL
M ECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
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
Approach /Sidewalk /—/g-0
Ext Other Date / Inspector
Final
PASS 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 Business Line: 639 -4171
BUP
Date Requested 7 /� AM PM BLD
Location b O S.t) 5ktel.Z.t.I. Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
dget G Tenant/Owner ELC
etaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: 110.e0 --‘;0040 Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
M�
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
• - ART FAIL
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
Approach /Sidewalk
of - Date �b�� Inspector ' y i/ Ext
- 4;5.►
t ov PART FAIL DO NOT REMOVE this inspection record from the job site.
3
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 /,
' / / BUP — DD '/3G
Date Requested y - Z �/ AM PM BLD
Location f5Z Y ' 5'1))-ti C-L.. S/ Suite MEC
Contact Person 8v6 Ph 3.17 1 c O 2 PLM
Contractor Ph 3/3 WV, c r ( SWR
BUILDIN Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT 1 -' 04 ' 40 0SV
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear l - r n / /, --� b
Framing 1 ) N ix l�f!., &. �Z✓ s� 1- p 0� P b
Insulation // ,,,,� ^ _ �,�}
Drywall Nailing / • /JAS F AL �i ��,,t // t€ ApikVtlkt - °'� 0 4` "
Firewall /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
M'sc:
Fin
ASS PART FAI
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
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
Approach /Sidewalk P
Other D Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.