Permit CITY TIGARD SITE WORK PERMIT
t�`'���v A DEVELOPMENT SERVICES PERMIT # : SIT1999 -00069
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 11/17/1999
SITE ADDRESS: 13588 SW WHITEHALL LN PARCEL : 2S104D6 -00400
SUBDIVISION: AMESBURY HEIGHTS ZONING : R -4.5
BLOCK: LOT: 004 04 " RISDICTION : TIG
CLASS OF WORK: ADD PAVING ?: . • RESO. NO: •
TYPE OF USE: SF GRADING ?: VALUE: $8,400.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Landscape feature: Rock wall in rear yard.
Owner:
FEES
CASCADE WEST CONSTRUCTION CORP Type By Date Amount Receipt
10445 SW CANYON RD
#103 PLCK GEO 11/08/1999 $74.59 99- 319536
BEAVERTON, OR 97005 FIRE GEO 11/08/1999 $45.90 99- 319536
PRMT DST 11/17/1999 $105.50 99- 319822
Phone: 5PCT DST 11/17/1999 $8.44 99- 319822
Contractor: Total $234.43
CASCADE WEST CONSTRUCTION CORP
10445 SW CANYON RD
STE 103
BEAVERTON, OR 97005
Phone: 641 -7424
Reg #: LIC 62678
Required Inspections
Misc. Inspection
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 these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Sign. ' e: / C /fit
Issu d By: jaeilmwm__,
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Call (51'1-639-4175 by 7:00 P.M. or an inspection needed the next business day
ti
(=ITV bF TIGARD Site Permit Application Plan Check# / / —/
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Recd By
Date Recd d / l -7 —f
TIGARD, OR 97223 Residence: Complete SHADED areas Date to P.E.
(503) 639 -4171 x304 Date to DST //male
4 „ /6 _ Permit #5 / T/ 9 149'00db?
v Related SWR #
Print or Type Called 11 S
Incomplete or illegible applications :.II not be accepted
Project Name Utilities (Complete all that apply)
Job L_ t -..` - 4 A AO' S (a t. tz 1-1El ot"
Address Address Storm Sewer
1' 38 st,6 2 41,10 lAw e- Linear Ft.
NamelCAgCADE WEST CONSTRUCTION CORK Sanitary Sewer
10445 SW CANYON RD. SUITE *WS 2S0 - Linear Ft.
Owner Mailing Addres tAVtIiIUly, lltf 11 iuu5 Fresh Water
Linear Ft.
City/State Zip Phone Catch Basins
S t 1 - .. 2 - 3� #
General Name Clean Outs
Contractor CASCADE WEST CONSTRUCTION CORP. #
Prior to permit Mailing A W CANYON R. 'SUI1' #188 7. r Describe work to be done:
issuance, a B EAVERTON, OR 97005 y
NewO Addition❑ Alteration❑ Repair
copy of all
licenses are City/State Zip Phone Additional Description of Work:
required if S 19 - S2 -? C. A i) cc '_ P >~ 1 l/ r
expired in COT State Cons Cont. Board Lic. # Exp. to / jt At 1 10 Rh- A g._ L I P k2 6
database & ' Z.& 7 i I 2//0/
Name Project
Valuation $ C3400
Architect Mailing Address Plans Required: See Matrix on back
The following, must accompany this application:
City/State Zip Phone Site plan with Vicinity Map Parking (including
Showing ADA compliance ADA) & Lighting Plan
Name Grading Plan and details Landscaping Plan
Engineer Mailing Address Erosion Control Plan and Retaining Structures
details including
City/State Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
(Soils report required for >5,000 cu. Yards) information given is correct, that I am the owner or authorized
cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill Volume Signature of Owner /Agent Date
(Soils report required for >5,000 cu. Yds.) 9r/hi 11 / (f/ f1 cu. yds. l
Will the fill support a structure Contact Person Name Phone
(Engineer required if answer is yes) YESO NOV 1
C
L Aiu D SC AP r —T(1 To c) c t A A. ci y � 5 1 , 238
Retaining structure? (check one) ❑Rock FOR OFFICE USE ONLY
❑ CMU Notes:
❑Concrete
❑Other /
/ 4-
Total new impervious area including all Land Use Case # Map/TL#
buildings, sidewalks, and paving Ft j� ,�P/ „?S /6 , 14F - Pktr
i:Wstslformslsite- app.doc 10/30/98 Pr' 11/.40,4 j�� q S �
11 ,/ ,G S
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical submittal, the application must contain the
signature of the supervising electrician before plan review will be conducted.
After plan review approval, Plans Examiner will contact the applicant to request
additional plan sets for distribution purposes. (Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
*B or B & M (Alt) 1
*B & M & P (Alt) 3
&M &P &E(Alt) 3
*B &M &P &E &F(Alt) 3
NOTES:
*Shaded areas designate ALT submittals only.
I: \dsts \forms\matrxcom.doc 10/8/99