Permit 5/ _4,
CITY TIGARD SITE WORK PERMIT
l4 DEVELOPMENT SERVICES PERMIT # : SIT2003 -00017
`�I II 13125 SW Hall Blvd., Tigard, OR 972 (503) 639 -4171 DATE ISSUED : 6/13/03
SITE ADDRESS: 10865 SW WALNUT ST PARCEL : 2S103AA 00101
SUBDIVISION: ZONING : R -4.5
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: ADD PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 446,000.00
EXCV VOLUME: 4,000 cy LANDSCAPING ?:
FILL VOLUME: 4,000 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT READ ?: N IMPERV SURFACE: 0 sf
Remarks: Repave existing parking lot, driveway & play court. No additional impervious surface, all is existing.
Owner:
FEES
SCHOOL DISTRICT NO 23 J
13137 SW PACIFIC HWY Description Date Amount
TIGARD, OR 97223 [BUPPLN] Pln Ck-Valu 6/2/03 $1,354.54
[FLS] FLS Pln Rv 6/2/03 $833.56
[BUILD] Prmt Fee -Valu 6/13/03 $2,083.00
Phone: [TAX] 8% St Tax -Valu 6/13/03 $166.71
Contractor: [ERPRMT] Erosion Cntl 6/13/03 $80.00
EAGLE ELS NE R [ERPLN] Ersn Plck -USA 6/13/03 $26.00
PO BOX 23294 [EROSN] Ersn Plck -COT 6/13/03 $26.00
TIGARD, OR 97281 Total $4,569.81
Phone: 628 -1137
Reg #: LIC 27112
Required Inspections
•
Erosion Control Insp 846 -8444
Paving 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 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6699. a.Lo Issu d By: 1. _, ,.. / . ' 1 0
Permittee Signature: X � ' ;
Call (503) 639-41 by 7:00 P.M. for an inspecti needed the next business day
O F Site Word
B D • • • • • FOR OFFICE USE ONLY
uilding Perm 1 !J it i . •`� r + l I_ ` R eceived Building
Date /By 5 Permit No.: oJr — a29 /7
City of Tigard � Planning Approval Other
y g JUN �00� Date/By: Permit No.:
13125 SW Hall Blvd. IV Plan Review Other
Tigard, Oregon 97223 CITY OF TIGAR p Date/By: Permit No \
a
Phone: 503- 639 -4171 Fax � �fIV L7 ply 96 NIS � !'� l / Date /By Case No. C on t ac t �� /"""( / ".t
Post- Review Land Use t fh w n (4
Gp1
Internet: www.ci.ti a rd.or.us � -• ® Se Pa
s � Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name /Method / ' � Supplemental Information
TYPE OF WORK REQUIRED DATA:
New construction ❑Demolition I & 2 FAMILY DWELLING o
Addition /alteration/replacement ❑Other:
CATEGORY OF CONSTRUCTION Note. Permit fees* are b*sed on the total value of the work performed Indicate
❑ 1 & 2- Family dwelling Commercial/Industrial the value (rounded to the n' est dollar) of all equipment, mosrials,- labor,
overhead and profit for the wor dicated on this pp-Hellion.
❑ Accessory Building Multi - Family
❑ Master Builder ❑ Other: Valuation -- / $
JOB SITE INFORMATION and LOCATION No. of bedrooms: o. of baths: '-----------,
�
Job site address: b9 - l..0 (A Z. (i,,,,�- S F , Total number oors �
New dw • g�cea-(sq-ft - ) - -
Suite #: — Bldg. /A t. #: r Garage /carport area (sq. ft.)
Project Name: �bq�1,ee' �` -(.zc L-t. ��t n..0 ,( Covered porch area (sq. ft.) S
Cross street/Directions to job site: Deck area (sq. ft.)
(..E °'` j 1 f coil l T F\ w y [tCe Other structure area (sq. ft.)
l REQUIRED DATA: N.
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: 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
(� will. 5f � rk� ^.I Jt
�lel (-0 • Valuation $ ( DSO
( `F (� �� `�� Existing building area (sq. ft.)
Ck
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER ❑ TENANT Typc of construction
Occu g roup(s): Existing:
Name: '17 cov D��' el i 23 New:
Address: loft b sc.13. a,. -1.4) h l9ir ;la 1
City /State /Zip: ` t'`� 7 2
• D 1- e 4 3
Phone: • l Fax: 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: ? ( r)(c, (.3 ke j d l° w , jurisdiction where work is being performed. If the applicant is exempt
Contact Name: _S ( £D 4 f it from licensing, the following reason applies:
Address: ,1Q St,3 Lo a_ m t ZO o
City /State /Zip: _ Foir-{-(,,,.,) t X11 - ■
Phone: ;63 22L, i,,¢ Fax: 5793 - 243 4(4Z
toed (( w.3 , �r7,•, . Please refer to fee schedule.
BUILDING PERMIT FEES*
E -mail: _
� _ Please
CONTRACTOR
Business Name: . !`4Fkrd giQ04.E- c6 Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: Fax: Date received:
CCB Lic. #: ; 1 1
Authorized `, 1 i ` Notice: This permit application expires if a permit is not obtained within
Signature: ,� A .,E�r!
— Date 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPennitApp.doc 01/03
po � � � q ((
I
SITE WORK PERMIT CHECK LIST
Commercial, Multi- Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: 4,00 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) 'qD cu. yds.
Retaining structure? (Check one) , /, ❑ Rock
❑ CMU
❑ Concrete
❑ Other
*Total new impervious area including all buildings,
sidewalks, and paving: -(G 04 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 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).
is \dsts \forms \SIT - checklist.doc 01/29/03
CITY OF TIGARD 24 -Hour
BUILDING r Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
kk � ,�� BUP 3 - Do 343
Received 4 �, Date Requested ' �� AM PM _ , BUP
Location lb U� 7 Suite 5/ / MEC
Contact Person Ph ( ) 0 q - 0'1`O p PLM
Contractor Ph ( ) SWR T.
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain ,Z _ coo p Slab Inspection Notes:
Post & Beam
Shear Anchors
1 Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall '
rink
e Alarm
Susp'd Ceiling
Roof
Ot G l - ' ?-- 7 DC
k 9p��� ART FAIL
ICIBING` .- -
Post & Beam
Under Slab
`Rough -In
Water Service n
Sanitary Sewer 4 /q/G,ir -, 5 S 1 '' 4 t
Rain Drains
Catch Basin / Manhole 4 p v e 7 1% 4 7 4 Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHAN ICAL=LY 5°
4 61(
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL_.;" ;.l'n'
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
V,. , ig 0 Please call for reinspection RE: ❑ Unable to inspect - no access
ire S uppl y L ine \T-1
ADA
Approach/Sidewalk Date �7/7/6) 6J,' Inspector - Ext
Other: . -
4Di DO NOT REMOVE this inspection record from the Job site.
"TrIP PART FAIL