Permit CiTY TIGARD SITE WORK PERMIT
i, DEVELOPMENT SERVICES PERMIT # : SIT2002 -00014
'`� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 6/28/02
SITE ADDRESS: 14111 SW WAGONER PL PARCEL : 2S109BA 04800
SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING : R -7
BLOCK: LOT: 030 JURISDICTION : TIG
CLASS OF WORK: OTR PAVING ?: N RESO. NO:
TYPE OF USE: UNK GRADING ?: N VALUE: $8,250.00
EXCV VOLUME: cy LANDSCAPING ?: N
FILL VOLUME: cy SITE PREP ?: N
ENG FILL ?: N STORM DRAINS ?: N
SOILS RPT REQD ?: N IMPERV SURFACE: 0 sf
Remarks: 2 rock retaining wall structures.Rear retaining wall abuts a varible width Public sewer and storm easement. The
second retaining structure will be constructed in a private easement serving several lots. THIS APPROVAL
DOES NOT AUTHORIZE THE VIOLATION OF ANY EASEMENTS OR THE RIGHTS OF ANY OTHERS WHO
Owner:
FEES
HANSEN, LE IF C +
CAROL M Type By Date Amount Receipt
14111 SW WAGONER PL PLCK CTR 6/11/02 $84.31 27200200000
TIGARD, OR 97224 PRMT CTR 6/28/02 $129.70 27200200000
5PCT CTR 6/28/02 $10.38 27200200000
Phone: 503 - 740 -3047 EROS CTR 6/28/02 $26.00 27200200000
Contractor: ERPU CTR 6/28/02 $8.45 27200200000
MOUNTAIN STONE CONSTRUCTION LL ERPC CTR 6/28/02 $8.45 27200200000
8805 SW GARDEN HOME RD Total $267.29
PORTLAND, OR 97223
Phone: 503 - 246 -3077
Reg #: LIC 124854
Required Inspections
Retaining Wall /Footing
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: / ' I �� -
(�
Issued By: i i -,`
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
~Building Permit Application
a r Date received: /, t n y Permit noC ,r 0� _i,�/ i
' `i City of Tigard - �r
Address: 13125 SW Hall Bivdy g 0 Project/appl.no.: Expire date:
97223
City of Tigard Phone: (503) 639 - 4171 Date issued: By: Wceipt no.:
Fax: (503) 598-1960 i�N 1 20 /� n Case file no.: Payment type:
Land use approval: . 1 Y Ur I � ' . 1 &2 family: Simple Complex:
TYPE OF,PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other: Z
JOB SITE INFORMATION ,
Job address: f IA (,P/ 7 q r g v' fL Bldg. no.: Suite no.: .)
Lot: I Block: (Subdivision: '7 'Tax map/tax lot/account no.:
Project name: n
Description and location of work on premises/special conditions: *rAiiiJaJa �T c_L.7
. OWNER ' • FOR SPECIAL INFORMATION, USE CIIL(KLISI' g'
Name: )'f,..vl.r r, vl Pf- ( F! ::odplain, septic capacit),solar ;etc') 1 N
Mailing address: / c / I f w Car o !) at a• amity d • ellin'. • .�
City: " •1 4 . f State: G I ZIP: - 7 2L A aluation of wor $
Pho ' - mr _ • a Fax: 13223111111= No. of a ' a : • s/baths 3
Owner's representative: V Total number of floors
Phonee/ - 79 9 • 0 i o New dwelling area (sq. ft.)
' APPLICANT Garage/carport area (sq. ft.)
Name: r h 0 v .rte' ✓'
Covered porch area (sq. ft.)
Mailing address: ) 8 a � _14.) J �j�,,l Deck area (sq. ft.)
City: m ✓ �, I Stat O 14641
ZIP: y'y yy 3 Other structure area (sq. ft.)
Phone`�•3 ,3 • ye 3. Rix! E- mail : / Commercial/industrialimulti- family:
CON "1'ItA(: h011 Valuation of work $
N Existing bldg. area (sq. ft.)
Business name: !� f-'/ Sh 4 ✓1 j G New bldg. area (sq. ft.)
Address: ,'j, C7 5 5yu Gtrrt ., Number of stories
City: 9q e�� I State:a V'' ZIP:S71 7 Type of construction
Phone: 5'63_ % 1 Fa 7 1E-mail: Occupancy group(s): Existing:
CCB no.: / 7 x3 a f S0 -a 6--o- New:
City /metro lic. no.: 1 3 * Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: I State: 'ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Lam T' •,v, .47Q L. fd Contact person: Fees due upon application $
Address: 4 t;) a N c Date received:
City: ie.- r` ?3-r 'State: B' (ZIP: q 7 2.6 / Amount received $
Phone:5a7 - 71L-`f I Fax:'/'' $ IE ilFjb 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 D Ysa 0 MasterCard
work will be complied with whether sified herein or not. Credit card number: Expires
Authorized signature: 1" -4--- Date 5' 7 - - "k 4 Y Name of cardholder as shown on credit card
C $
Print name: I. (`1 11 V !r s� v Cardholder signature Amount ■
Notice: This permit application expires if a permit is not obtained within 180 days after it has been acce red ascomplete. abl3 (6roo /CCM)
b ` � ') I �a� ado . 3�
n . ! 4 1 0
7 10 3 8 ■
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SITE WORK PERMIT CHECK LIST
Commercial, Multi - Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
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 must accompany this application:
Site Plan with Vicinity Map showing *Parking (including ADA'
DA) 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.
TYPE OF SUBMITTAL # of Plans
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).
: \dsts \forms\sitechecklist.doc 09/24/01
CITY OF TIGARD 24 -Hour
BUILDING , Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received } ` ate Requested /U / AM PM ' iv ` BUP
Location / 4/ //I 5 LA) wX yi■ j2,e Suite MEC
Contact Person Ph ( ) / O' F6 Z' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT v Z /
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall Fire Sprinkler
Fire Alarm / 141'
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.
PART FAIL
Please call for reinspection RE: Unable to inspect - no access
it pply Line
ADA Date " / II / O'L- Inspector ` ( Ext
Approach /Sidewalk
Oth - r: 44,/cat f p CI,
ulrei DO NOT REMOVE this inspection record from the Job site.
FART FAIL
-