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Permit ',CITY OF TIGARD SITE WORK PERMIT i� DEVELOPMENT SERVICES PERMIT # : SIT2004 -00007 `�'` . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 3/10/04 SITE ADDRESS: 11355 SW TIGARD ST PARCEL : 1 S134DC -00600 SUBDIVISION: ZONING : R -4.5 BLOCK: LOT: JURISDICTION : TIG CLASS OF WORK: NEW PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: 500.00 EXCV VOLUME: 10 cy LANDSCAPING ?: FILL VOLUME: 10 cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: Y IMPERV SURFACE: 440 sf Remarks: Site work for installation of cell tower. Owner: FEES Description Date Amount [BUPPLN] Pln Ck -Valu 3/8/04 $40.63 [FLS] FLS Pln Rv 3/8/04 $25.00 Phone: [BUILD] Prmt Fee -Valu 3/10/04 $62.50 [TAX] Valu 8% State Sui 3/10/04 $5.00 Contractor: [ERPRMT] Erosion Cntl 3/10/04 $80.00 SCHOMMER + SONS INC [ERPLN] Ersn Plck -USA 3/10/04 $26.00 6421 NE COLWOOD WAY [EROSN] Ersn Plck -COT 3/10/04 $26.00 PORTLAND, OR 97218 [WQUAL] Wtr Qual % 3/10/04 $225.00 [WQUANT] Wtr Quant ° 3/10/04 $275.00 Phone: 287 -4646 Total $765.13 Reg #: LIC 4937 Required Inspections Ersn Cntrl 681 -4444 Fill 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. Issued By: / Permittee Signature: jl , Call (50�+�•39 -4175 by 7:00 P.M. for an inspection needed the next business day Site Work Building Fermit A IIC 'RECEIVED � ' . FOR OFFICE USE ONLY • City of Tigard LIAR g 200 Received . J 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: D 503.639.4171 ' Fax: 503.598.1960 C►TY OF T► J l' B .• Date 0'0 ■ ) l Other Permit Inspection Line: 503.639.4175 3t' _ .. Date Ready/By ® See Page 2 for � - � y ' Internet: www.ci.tigard.or.us BUILDING Notified/Method: , Supplemental Information '"' - - ` -", '--:'-; ;-. - '''' , k - TYPE-OF `.WORKS , =,' "^ RE UIRED DATA: 1 =AND 2- FAMILY DWELLING:" 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 he =- ?r work indicated on this application. - , _ -"' '- "" a :: - ' " : 4 _ ,.. ... ., iz% x - _fi .. rx•_.. s _ ..,; ,. .�k.. - .Nn , ._, - . "h, a ns .,. : ,. ❑ I- and 2- family dwelling Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi - family Number of bedrooms: El Master builder ❑ Other: Number of bathrooms: ';*'''-'4',5:7 SI . - ° f" ' ` ' Total number of floors: -? dOBa " INF 'A , ,,,, ION . ,,- ,OCATION `1„ ` :i , 1 N" , Job site address: \V"rj55 5- -1, . , II: 't-Q iL� New dwelling area: square feet 11 City /State/ZIP: - - 7 ., ` c. k . CZ. Ck Zz3 Garage/carport ,. ea: square feet Suite/bldg. /apt. no.: Project name: paz., ec_f(.3 Covered r .rch area: square feet Cross street/directions to job site: C,q A(5 D - • area: square feet Other structure area: square feet a REQUI( RED DATA: =COMMERCIAL -USE CHECKLIST.; Subdivision: N3 P ■ I Lot no.: Mc, 00 Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the 3 " "-- DESCRIPTION ,OF WORK = .. = "':%'. work indicated on this application. In.3�aaNCLA:COQ °e, (i)O - Kl t' l r.� ■ kolas �Ot0t_ Valuation: $ , Cj °o 0.AA CTZ 1. �} S- � f , w Existing building area: square feet New building area: square feet CIPROPERTY OWNER , V` ,: Asa ; � -���`� ` a`�`', . +�'t`,;. . � 3 -, , .'. : . Number of stories: , Name: La . k - . I '. • Type of construction: Address: l o r _ , ` f rei ct , Occupancy groups: City /State/ZIP: • I I 0i. I Existing: Phone: ( ) . Fax: ( ) New: PLICANT = -=' -: 0 :`CONTACT PERSON f Business name: \) Q - M 1 (`� .j5S . All contractors and subcontractors are required to be Contact name: S O(oh{sa__ ' 1t+\���(�S 1 %,),) All with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: VI 5 - -D 3 l.t.30. cLr jurisdiction in which work is being performed. If the City / State/ZIP: ��� cR + 3 �j applicant is exempt from licensing, the following reasons apply: Phone: C503 ) °173, S'V4( I Fax: : ( q 13 , 3\4.513 E -mail: '` K4711 ::- ;CONTRACTOR:`` ' r ; = ., f ^ Business name: „ 1 L01 1 lie �/s�L� ;,; ..,.. ' .> ; . :�a o �' �` � . = "'BUIL;DINGPER)vI , ;e; Address: L p 4 2 i N c. oo l v , ( o 1 w Please refer to fee schedule. City /State/ZIP:4 r9 ® 1 r ( az L 1 Fees due upon application Phone: (603 2? F -Lk.P4 L.P Fax: (6 03) 28Z7 1:RC:1 4q��- Amount received CCB lie.: Date received: ,tizeti Authorized signatur . This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: cc-y- ► Li e �/ • Date: 3 / $ / * Fee methodology set by Tn- County Building Industry �i� t L( � � Service Board. lAuuddmg \Pcrmils\SIT- PcrmnApp doc 12/03 440 -46 I 3T( I I /02/COM/WCII) - , City df 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: 10 cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) I 0 cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) 10 cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU n ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 44-0 sq. ft. 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. �� zi,�� . o ans . ::T:YPEOFwSUBMITTAI `' :: ` Re uired ate' R A' °Submittal- ^, . • licludes;:" New - Addtions�or �Alterations� Commercial 2 Multi- Family R -1 Occupancy 2 One- & Two - Family Dwelling 2 is \Building \Forms \SIT- PermitApp.doc 1/13/04 2 EROSION CONTROL NOTES: 6\ 1 1 . O OF DESIGNATED • PERSON SHALL BE RESPONSIBLE FOR PROPER W ' 1 In INSTALLAIIGI AND MANIDUMCE OF ALL EROSION AND SEINE NT CONTROL �. - g MEASURES. Di ACCORDANCE WITH LOCAL, STATE. AND FEDERAL REGULATORS. de B ti e N 4.-0' g1 I 2 THE OD'LFLDRTADON OF MS ESC FLAW AND NE OG6DNC EN, WMIDUNCE, o g m r -6' ,•,;( dd c Ps CITY OF TIGARD OF ,Iff NT ""D / " � P N G`"°dG �` N , y S S ire W O Ii i AND APPROVED Am Y£O Al li LD ALL S FSTA6L19 ® . Tiff DEUELOPEER o: ._ A �� LOTS F WLd11D1A MIER 1HE PROECT IS APPROVED a C i. me' Approved ( ): p e h Q 1 THE BOON DARES OF THE CLEARING TH G LOOTS 91001 S PLAN SKULL BE ° W W For only the WU aS described in: CLEARLY RIMED N THE RID PRIOR TO CONSTRUCTION. DURING 1HE ; 4 z o: 0 ' 6 �' tl i PERMIT NO ' L D 0 4 �- d 0 0 D ' - CONSTRUCTION PERIOD NO GSNRBAICE BEYOND THE RAGGED WARPS a. ■�G� � , UNITS SHALL minim. nim. THE 'mawS SHALL BE MANTAIN D BY THE g - �� W APRICANT/CONTRACTCR FOR 110: DURATION OF �' 8 Le See Letter to: Follow = 2 Y 4. 11E ESC FAC0J7E5 910811 ON THIS PLAN MUST BE CONSTRUCTED N P O ° - W f3 «< g Z 4 a ., 4 Attach p. � ( ): A AS CONJUNCTION m � THAT sm�umNr AND s LADEN wA1ER Job Address: / / 3 S� w —' Ti 6A1L!) 577 A � � � By: 151% 114/ Co LA LO lc Date:t /O-Y WATER RS'TTAND ME DIUNAGE SYSTEM. ROADWAYS. oR VIOLATE APPLICABLE S. THE ESC FACADES SHOW GM THIS PLAN ARE ME MINIMUM REOUIRFNa its i FOR ANRCD'A1ED SITE CONDITIONS DURING 11# CONSTRUCTION PERIOD CF 1 - I THESE ESC FACILITIES SHALL BE UPGRADED AS NEEDED FOR UNEIIPECIED I STORM EVENTS AND TO ENSURE THAT SEDIIBNT AND SEDIMENT LADEN p . NAIER DO NOT LEAVE THE SITE. 99 may \� = ■ 1 HmIOES 91ALL NSECIED P 1NE AN 1 6. T I CONTRACTOR E ESC FA AND YANTADBD BE AS NECESSARY DAiY TO BY ENSURE APPLIC THEIR T/ mum — / S ■ FUNCTIONING o ............ % I • I 7. AT NO 101E SHALL SONDE BE ALLOYED 10 ACCLIMULATE MORE THAN ............ ............. ■ ............ BARR IB IGIT ALL GTCH BASNS A16T CONVEYANCE lMf3 ......... 13 • 1 I 1 ALL CLEANED PRWR 1D PA THE CL EANING OPFRA110NS SHALL 0 ........ ......... ......... 3 :::::::� t W------- - - - - - - -- NOT FW91 SIDOBNT -LADEN CORNER N1D THE DOMNSIREAM S1S1EY. w 5 _ I a STABILIZED GAVEL ENTRANCES SHALL BE INSTALLED AT THE BEGBOING '�01 I '';;: %\ ' s H 0 u si / ; > 1 ■ • • I 11 s I AD ADDI IONAL�MEA J1 SS MAY BE RE 1 N THAT THE PROICI < • I N ;:. $ Z < W — i I' ARE KEPT CLEAN FOR ME DURATION CF ME PRO,ECT. z o c o = O ° Q 1 �. I Y INLETS BASOS DS BE ROTCT i N 6 i J 210 A STORDRAIN AND AREA DRA PEED ..6 `J�' ,� ■ d = I , i , , 'ra , RE- ESUBL19iED. ■ ii /� _ w�WL II D'� to PAVEMENT SURFACES Me VECETAltG1 ARE TO BE PLACED AS RAPIDLY w 99 �i „� ' 11. SEEDNG SHALL BE PERFORMED NO LATER THIN SEPTEMBER 1 FOR EACH Nn a- o r ' — I �`� 1R / PHASE OF CONSIRIICIION. 6' / -- _ 1 - .ry . . _;� - ��.�'- OCTOBER 1ST THROUGH APRs 3 1 12 IF THERE ARE OROa1D =as OR was NOT FULLY ESTABLISHED FROM 6 SET MEANER EROSION PREVENTION < , MEASURES WILL BEN EFFECT. SEE TTHE EROSION PREVOITIGN AND SEDIMENT p� o+ ,` �� CONTROL PIAI/1NC Am DESIGN MANUA RE PRR 4) FOR REWQEICENTS. O . Fr o a li I ' f 1 ", ar a t r ` s� t •I• '- s! •,— I 11 HILLY DEVELOPER STALL REYOUE ESC YEA51JREs WIBTI VEOETA110N 6 4 . - • L r } �.K: T tv ' 1 1 s ' e'..-,- 1 FULLY ESTABLISHED. SEDIMENT FENCE Detail Droning 4-16 I , y a ~` }f <1 g 4 .:5z;,,_.: T y • `_ * 1 2sob ( ; ' • SFr x „)„,;..1-,,,,:,-...,.,..,-,,,,,.::..=,,,: tr , ,/ L . ` �Ta`_ { . \ 2.05 0 Page 4-81 c . : -, •- I • 1 ,- Sil- 1 r : x '''.= INSTALL TA FENCE !J 1 A .--.1 1 . % t tr l' - ' PER DETAIL 16, 1 \ __ t• Q CC I : i ;" � . 1 7 :.'F'^', - . - 7,' - i•.: ' , I 1 I- j' • - THIS " - j il 1 ■ - R '; *IN Zr) 0 0 w Y BE USED SNORT 11:911 r /^ r/ umm eDRlc Alm r/ I / li� 1 ' '1 . � \ 1 �•I ►� �•, CI rHti�Na a DElanrlewr • Z t 2 IQ ea Q 1P° Is WE IIIIIII U1111 • , •� . ... 0 I nW h ' inl ih: I I • t A "r k \ 4 9S 1 ., ■ 20' HORIZONTAL N Q I- o ln i(ii i I . - i 1 - 1 1 Z sal Aix '1 0 , CATCH BASIN AREA DRAIN ZZ ` nc - D s F: 1g5 TAX LOT 700 ; �}; f, • 60 1 ® / , W 1rnl � r ' 194 ■ 3 W 'I 11i; , '�,,, ' fa 1 1 1 , FLEW - 1 III 1 1 ' I rush ti # - rii1 INSTALL SILT FENCE 1 u , I 1 93 1 ii - 6 ' ewlap el Daga PER DETAIL 4-16. THIS SHEEN 1 A�': 1 VIEW I 11iilil, .` eC 0'1E,, j NST 1 1 1 ' PLAN VIEW IVil!:, NSTALL BLOBACS ALONG EK. DITCH '— BTOBAC PROTECTION SWAG PR PER DETAIL 4-24, THIS SHEET. 1 EX CATCH BASH. PER FOR • ETCH BASIN 1 a�. 1 1 R ,1,.., T AIL 4-24. THIS DET,4- U9 0.....____ -./1111111111111.m,_ 11101111111 45 P .rte - � _ � ' �� CD .::_ : „� FLAW - - �; - - �'# �H ��..RH c c r1a o10~ O O 6 D ( s.,.,...__�0 0 - g Lam,. -�.,.. _ - _ - _ VI I . N T I 811T TIGARD H9T o _ q �a Z� 10 .74 Cing:Iii)11 - - -- - — — - _ - - i W o u W « 1 DITCH INLET ,_L____ 1 riot /90 • — — Lo r4 NOTES , ww •••• ■m �Di • a - ° c 'es ... 1. ADDITIONAL MEASURES MUST BE ��• - - - - - `�o_ _ - •' O n c‘i in SOIL PE TYS - - - - -� CONSIDERED DEPENDING ON S _ 189 2. SOFILTER BAGS SHOULD BE STAKED •'' f -- --- -- - - - -- •• Qp *ENE APPLABLE U9NC 2 VE d ------- - - - - -- - -- OFFICE COPY Of) • O YYDOD STAK OR A� EQUAL PER BAG. � . � �.. •� 1 18 M INLET PROTECTION Detail Droving 4-24 ) N , . ' , TYPE 4 U i Page 4-109 EROSION CONTROL AND GRADING PLAN: SW TIGARD ST I I I 'ii CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50 , ; 4 T. 175 INSPECTION DIVISION Business Line: (5.. ' 1 MST 6/3 a./4 Am Received Date Req T d AM PM BUP Location t l c ��' % Suite `` I MEC Contact Person Ph ( ) al ? T7't S PLM Contractor /n� AAnn h( SWR BUILDING Tenant/Owner VJe. b 15\71 % LC Footing Foundation ELC Access: Ftg Drain , 14 y _ 6 a 0 c ELR Crawl Drain 2 0 f 00667 Slab Inspection Notes: V Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm \\ Susp'd Ceiling Roof Other: I 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 D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PA.. PART FAIL TE' Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date �j�b Inspector Z Ext Other DO NOT REMOVE this inspection_ record from the Job site. ASS PART FAIL