Permit 1
•
SITE WORK
CI1i T I GAIRD REKN # PERMIT o a SI T95- 0017
• .COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/31/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
SITE ADDRESS...: 13970 5W PACIFIC HWY
� PARCEL: 25103DD -01 201_
SUBDIVISION....: ��� eb ZONING: C -G
1'�I_OCK, ........ n LOT 9/ )
TYPE OF WORK: NEW PAVING ?......... ; Y RESO. NO
EXCV VOLUME.: cy GRADING? ..... ... :Y VALUE... $: 11500121
FILL VOLUME.: cy LANDSCAPING? = Y'
ENG FILL ?......sY SITE PREP ?......:Y
SOILS RPT REQD?:Y STORM DRAINS ?...:Y
IMPERV SURFACE.. :9645 sf
Remarks: Chevron station and office bldg. SITE WORK
Owner: - - - - - -• ' -- FEES - -----
CAIN PETROLEUM type amount by date recpt
2624 PACIFIC AVENEUE EROS $ 80.00 B 07/31/95 95-268681
PRMT $ 470.50 - 8 07/31 /95 95- 268681
FOREST GROVE OR 97116 5PCT $ 23.53 B 07/31/9; 95- 268681
Phone #: 357-9711 PLCK $, 305.83 B 07/31/95 95 -- 268681
Contractor: - - - --
MONTf�: DEVELOPMENT, INr. -
P.O. BOX 130
SANDY OR 97055
Phone #: $ 879.86 TOTAL
Reg #... 46838 -'
REQUIRED INSPECTIONS -
This persit is issued subject to the regulations contained in the Erosion Control , _ —
Tigard Municipal Code, State of Ore. Specialty Codes and all other Excavation Insp —
applicable laws. All work will be done in accordance with F i l l Inspect i on
approved plans. This peruit will expire if work is not started Grading Insp
within lag days of issuance, or if work is suspended for acre St rm Drain Insp
than 180! days. Reinforced concr
Engineered gradi
Final Inspection •
Permittee Signature: - +,
Issued By:
Call for inspection - 639 -4175
•
•
•
" Commercial Bu'idin • Kir it A • • lication
•
City of Tigard /or. )
- 13125 SW Hail Blv I le ‘A ' ot ct ...k ,, . / i
72 k i l
Tigard, OR 9 0 -q 1-) . i
(503) 639-4171 .
2 (
... .
Jobsite Address: /? , d $ k) Pel' 6 A / ' V ‘-7 "
/
'Ibtficiisliiiiit tiltrgiV,WIA,Xkiak.:0'.:
ggojaiiwiliklem§
Valuation: - //.--- (.0 oe .......;,...?::::.,:::*:::.?.:.:::&.:::::::t..Ra:.,0::::::.,:::::::::::::?:::::)::::::.:n::::::4;
/ OPegiiilirtiOiti:gfA:4:::40,:1;:i.:1
Owner C,1 o i a / el.& 2-,- ;'. i . .,:'
::::4 di i . k LIF , :mR.::..:,::: , .. ,..,....?...:....:.::':.%:.:.....: -..f.'
Address: '.:•Aiiiiiii.iiifi:Fteqiiiiiiiiet?;;U:ga.:::%ign::!1':::F.,:::-::•:::
i.t.C
iii0g4V:i
*::.:....::::..4:
s
Phone: MgrigineerirlWa::::M.:.S1s,:as5:x:,i,:§-s,:i.:::::::::-:*:::::-:::::,;wk?F.
7i
O ttier:•.' : : . .. : ;:•:-'....-.::-5 . :.. i. : - ::: : .2* . ! . :% . *:
Contractor: ) S ATIev P.I.i'eA0 e
i •1
i ...,.„,
Address: -0 • 6,Y t (_)
X 0 V - q/05 Type of const:
Occupancy class:
Phone: 9) -1 al -t-144
Sprinklered? Yes No
Contractors License # 4. 12- - i --e
-
a copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Story (1st, 2nd, etc.)
Proposed use:
Architect/Engineer:
Previous use:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone:
JOB DESCRIPTION: ..5 77 e bt ) a r k F 0 a 7 e ell _...FG1 e ) ...17
4 , to i - 1 f 22-‘,1 ee // e) -/:-/--/ c
Applicant Signature & Phone number
Received by: Date Received:
Permit # Account Description Amount Amt. Pd. Bal. -Due
Bldg. Permit (BUILD) • - 1 47 O - 4 2 12 —
Plumb. Permit (PLUMB) . .
Mech. Permit (MECH)
State Tax (TAX) 7— 7 53_ S
Bldg: _..... =z� .. •
• Plumb:
Mech:
Plan Check (PLANCK) d U S
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TiF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
a
Office TIF (T1F -0)
Water Quality (WQUAL)
/ X P J ` 1 Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) cf' vv
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: P? y D 7 7 1,e
`�
03/30/2000 Activities for Case #: SIT95 -00017
10:12:25 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SITA007 Application received JHF 06/30/1995
SITA010 Plan check by 06/30/1995 JHF 06/30/1995
SITA020 Check for prcl. restrict. 06/30/1995 JHF 06/30/1995
SITB180 Devel review cond. met JHF 06/30/1995
SITB700 Erosion Control Insp 844 -8444 JHF 06/30/1995
SITB705 Excavation Insp JHF 06/30/1995
SITB710 Fill Inspection JHF 06/30/1995
SITB720 Grading Insp JHF 06/30/1995
SITB740 Strm Drain Insp 09/12/1995 GS PASS HAP 02/29/2000 Entered from review of records
PLM95 -00153
SITB773 Reinforced concrete final rept JHF 06/30/1995
SITB775 Engineered grading final reprt JHF 06/30/1995
SITB799 Final Inspection 09/12/1997 JT NOTE JT 09/28/1998 see log note 9/28/98 inspection
request (research) sent to Hap
SITA070 (F) Ready to issue 07/31/1995 JSD CTR 07/31/1995
SITA080 (F) Issue permit 07/31/1995 BON B 07/31/1995
SITC180 Expired by limitation 02/29/2000 HAP EXPI No Hold HAP 02/29/2000
SITC770 Misc. Inspection 02/29/2000 02/29/2000 08/24/1995 MS PART No Hold HAP 02/29/2000 oil separator line needs to be
tested (entered from review of
records PLM95 -00153
SITC770 Misc. Inspection 02/29/2000 02/29/2000 08/25/1995 TLP PASS No Hold HAP 02/29/2000 oil /water seaparator (entered
from review of records
PLM95- 00153)
SITC799 Final Inspection 03/27/2000 AKJ RECD No Hold AKJ 03/27/2000 rec. affadavit from Campbell's
Plm and Heating General
Contracting on the underground
waste ■
SITC185 Return permit to issued status 03/28/2000 HAP PASS No Hold HAP 03/28/2000 Fee paid for reinstatement and
final inspection (BUP95- 00247)
SITC799 Final Inspection 03/28/2000 TLP PASS No Hold AKJ 03/28/2000 _--L
SITC800 Case Finaled 03/28/2000 AKJ DONE No Hold AKJ 03/28/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
•
24JIour Inspection Line: 639 -4175 Business Line: 639 -4171 non UP qS -- 4 /7
Date Requested -- ;24r* -- 69C7 AM A - PM N B� Cf, c �i/
Location 14/ 7� 4A rd Ai Suite MEC 9 -
� dO,/2
Contact Person j a g- k ' y t #14 Ph 7 $ � PLM
Contr. or Ph SWR QS' 203Drq0
�= Tenant/Owner l�7 '� ELC
Retaining Wall ELR
Footing Access:
Foundationb < L� FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notesn„ n, � i / r
Post & Beam
�LCtUI 1 /1/0 SIT ifS MO 7
Ext Sheath /Shear nu,7 a4e 41 r —
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Mi .:
Ire PART FAIL
P BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ost eam
Rough In
Gas Line
6 S e Dampers
<( : AS 'v. PART FAIL
E TRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
• . SS PART FAIL
'a -ding
k� -� :
[ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk / I /
o Date ..3/2•870 CJ Inspector Ext
) PART FAIL DO NOT REMOVE this inspection record from the job site.