Permit CITY TIGARD SITE WORK PERMIT
4 DEVELOPMENT SERVICES PERMIT # : SIT2003 -00002
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 11/21/03
SITE ADDRESS: 11365 SW TIGARD ST PARCEL : 1S134DC 00700
SUBDIVISION: ZONING : R -4.5
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 150,211.00
EXCV VOLUME: 100 cy LANDSCAPING ?: Y
FILL VOLUME: 4,328 cy SITE PREP ?:
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: Y IMPERV SURFACE: 46.200 sf
Remarks: New Construction
Owner: FEES
BAPS TEMPLE
PO BOX 41160 Description Date Amount
SAN JOSE, CA 95160 [BUPPLN] Pln Ck -Valu 2/4/03 $610.55
[FLS] FLS Pln Rv 2/4/03 $375.72
Phone: 408 [BUILD] Prmt Fee -Valu 11/21/03 $943.20
[TAX] 8% St Tax -Valu 11/21/03 $75.46
Contractor: [ERPLN] Ersn 11/21/03 $32.50
MEGA PACIFIC [ERPRMT] Erosion Cntl 11/21/03 $32.50
PO BOX 82186 [FLS] Addl FLS PlnRv 11/21/03 $1.56
3777 SE 21ST AVE [ BUPPLN] Addl Pln Ck 11/21/03 $2.53
PORTLAND, OR 97282 Total $2,074.02
Phone: 238 -3772
Reg #: LIC 00063108
Required Inspections
Erosion Control Insp 846 -8444
Fill
Retaining Wall /Footing
Paving Insp
Sprinkler supply lines
Fire system test
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.
By: A16
A Li
Permittee Signature:
Call (503) 63 by 7:00 P.M. for an inspection needed the next business day
Site Work / /3 (.°3 1" i' _''d--' .
. Bn ding Permit Application FOR OFFICE USE ONLY
R eceived $ Building
Date/By i - 31 .....9•?_ a Permit No.S(T cno3 -0°000 9 ,
City of Tigard EC E I V Planning Approval Other
, ` Date/By: Permit No. •
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 I Date/By: 7 -IS' f°�� Permit No.:
Phone: 503- 639 -4171 Fax: 503 -5980 � ' • 3 � !8' . 4 : I n � p y(�' ' l l f 1 6 Post- Review Land Use
r i Date/By Case No.
Internet: www.ci.ttgard.or.us OF ` Contact tuns.: ® See Page 2 for
24 -hour Inspection Request: 503 - I L 5 NG DIVISION Name /Method Supplemental Information
TYPE OF WORK' REQUIRED DATA:
1 New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, matenals, labor,
overhead and profit for the work indicated on this application
❑ Accessory Building ❑ Multi- Family
❑ Master Builder 1X1 Other: 7EMPt,E Valuation . .... .... $
TE INFORMATION and LOCATION No. of bedrooms _ No. of baths:
Total number of flo
Job srte�a'ddIES 1 r �� W • 6•AAD S T New dwelling area (:,, `,. .
Suite #: I Bldg. /Apt. #: Garage /carport area ft) ...
Project Name: f3 • A • r, 'TEM PL6 Covered porch area (:: ft )
Cross street/Directions to job site: Deck area (sq. ft.) ......
Other structure area (sq. ft )
IIS 714 Avvul•
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #: 700
Tax map /parcel #: IS I3LIDG 00700 Note Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, matenals, labor,
overhead and profit for the work indicated on this application. / / I �
NEVI CoNSTQL4G7 /O N 0 P A V
- rem Pi4 Valuation 7 $ fan
Existing building area (sq. ft.
New building area (sq. ft.) t.>6?.D
Number of stories
TEL PROPERTY OWNER L' TENANT Type of construction..V 1 .H0Vt
Name: 13 • A - _ P•s . re m Pi_ d Occupancy group(s): Existing:
New: ___ _ t; ,
Address: P• 6 • 6 6 K 4 11 bo
City /State /Zip: SAH ?a of , r 9516
Phone: L{oy -4n— 1,t1b Fax:LLa - 453 -o L3Z NOTICE: All contractors and subcontractors are required to be
❑ APPLICANT ® CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: PA(zEs PA76L. from licensing, the following reason applies
Address: P• O . 66 0, L 1) i s - -
City /State /Zip: S l► 'Z'e d 1 eA 9S166
Phone:LfDg - 453 - 61464 I Fax: 4c*-453 0 2.3t.
BUILDING PERMIT FEES*
�
E -mail: PAO 6514 1P I TKSMe.MI we. • CorA Please refer to fee schedule.
CONTRACTOR
Business Name: Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received.
CCB Lic. #:
Authorized , Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
A A N 4764. *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
- leEV 4 6/ 61 ' !:b )
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 , ,,1,
PLs ',75 7
. , _
SITE WORK PERMIT CHECK LIST •
Commercial, Multi - Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
•
Excavation Volume: - 460 cu. yds.
Grading Volume: . �
(Soils report required for >5,000 Cu. yds.) /' 8 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 i <�vJ7arn
*Total new impervious area including all buildings,
sidewalks, and paving: I ZOD 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 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 1 and 2- family dwellings.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 4
Multi - Family R -1 Occupancy 4
•
One- & Two - Family Dwelling 4
NOTE: Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
• additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
•
- is \dsts \forms\sitechecklist.doc 09/24/01
CITY OF TIGARD 24 -Hour
BUtiSeiNG Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
el/7 (a- AM PM BUP
Received Date Requested BUP
Location ( 1; � �C �� Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT ZP'33 —
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation •
Drywall Nailing a
Firewall
Fire Sprinkler
Fire Alarm gra 11111
Susp'd Ceiling /`
Roof
Other: -
Final 44r
PASS PART FAIL
PLUMBING I
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.
. PART FAIL
ITE El Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Ot •
DO NOT REMOVE this inspection record from the Job site.
ASS ART FAIL