Permit C ITY OF TIGARD SITE WORK PERMIT
',-* ,1A DEVELOPMENT SERVICES PERMIT #: SIT2004 -00010
"III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 -4171 DATE ISSUED : 8/27/2004
SITE ADDRESS: 13680 SW PACIFIC HWY PARCEL : 2S102CC -01100
SUBDIVISION: ZONING : C -G
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 15,000.00
EXCV VOLUME: 10 cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: Y IMPERV SURFACE: 485 sf
Remarks: Site work for new cell tower. .
Owner: FEES
TIGARD LODGE #207
PO BOX 230184 Description Date Amount
TIGARD, OR 97281 [BUILD] Prmt Fee -Valu 3/25/2004 $187.30
[BUPPLN] Pln Ck -Valu 3/25/2004 $121.75
Phone: 503 - 625 -4084 [TAX] Valu 8% State Sui 3/25/2004 $14.98
[ERPRMT] Erosion Cntl 3/25/2004 $80.00
Contractor: [ERPLN] Ersn Plck -USA 3/25/2004 $26.00
MONITOR MASONARY CONTRACTORS [EROSN] Ersn Pick-COT 3/25/2004 $26.00
32647 S MEREDIAN RD Total $456.03
WOODBURN, OR 97071
Phone: 643 -2728
Reg #: LIC 00058177
Required Inspections
Ersn Cntrl 681 -4444
Retaining Wall /Footing
Reinforced concrete final rept
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.
Issued By: s� ti,, e
Permittee Signature: rc . .,i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
13 6 02(01/2004 15:32 FAX 5035pv..,9y V1 c) CITY OF TIGARD RI015
$j PACPAC./F"- /F if
Site..Work r. --k
• .,
. . -
Building Permit Apphc . A 1 1, , ISO
li FOR OFFICE USE ONLY
City of Tigard d t'l\ .siND Receive
Dams , ja igrminT Permit No.:. ,r; , , -coo • ---
13125 SW Hall Blvd., Tigard, OR 97223
(NO‘ ,4 tint Review ... .. 4.-1-011 Other Fent*:
Phone: 503.639.4171 Fax: 503.598.1960 -csi — "-" vryil
Inspection Line: 503 0
.639.4175 ‘ ‘A -A- '
0 ---- --- Date . - . :y; 113 See rep 2 ror
if gepplemeztel Information
Internet: . ... .ci.tigard.or.us kl-. \‘'. NotifieObteutes:
— 1060/ o
1 ..r! . - r2
New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
0 Addition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the
f.1 ,.. ;, ,..i . .;.. :i 00 8.: jiii.. . 0:::, .. Noitoink.4. f r , ..i,. r :,.. ; !. ,:!..:_ ; .,.......: werk indicated on this application.
Valuation: S t's e_..
0 1- and 2-111mily dwelling e 2tommacial4ndustrial
0 Accessory building El Multi- Number of bedrooms: family
El Master builder 0 Other: Number of bathrooms:
I.4.::1:" : •.' .'' Total ntnnber of floors:
Job site address: iSkeo ,t...2 PA0C1c. 1 4.0.1 • New dwelling area: ' square feet
City/State/ZIP: 1- o e.. erivvs Garage/carport area: square feet
t
Suite/bldg./apt. no-: [ Project name: WAND& CrP1 Coveted porch area: square feet
Cross street/directions to job site: Deck are square feet
)( Mei:Wald ti • Other structure area: square feet
.2.111/
•S A 1Cb ON 43 Se/20 •
IMMO .: ItEOTOWATAICOR : \
Subdivision: Lot no.: Permit fees* arc based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map/parcel no.: 25 102. C... CI 1 i 00
equipment, materials, labor, overhead, and the profit for the
l ..V I ::1t 7 .: - ' , Illd if llEstitirikkiiiiii ..Siicjiii011,..F .-: f . : ..i .. 1.4.: it: work indicated on this application.
.--nsocnatiz pad ( re-Mho/A.78' G.21-I/ Valuation: $ f 5 0
Existing building area: square feet
New building area: square feet
; : i •■ • : 1 4 ; 1141 . 140:104** *.r.t00..... ..'.. '.iTii . .1 0 '' '.' i1 .: 1 . :" ;! ;, I.'.: Number of stories:
Name Ti egNaD ipiNz. +I 20 Type of construction:
Addressib SC Nie 250%e4 Occupancy groups:
CitY/StateraFeCer LW C• oe_ 4r776/
------ / Existing:
Phone: 6 WS -4oes* Fax: ( ) 2.)ta4 twat" New:
; ::::!::::• ivi.i iti.... ...5,.,- .7 r
I -.. 1 ..%-.4."..: '
.!:.`.1L.:iiti,:..yu ::•:.i:47■.;:irrinn7r.' -_::. i.. .1. • •••• - .. r;.rii: : l'... , 1 . - • . • •:. • • ..,, , '4 ,', li;•.1; ';??....lirmy:11.'....i • • ‘, .... : • :...........,, .;
Business nameW castynarn Lanai o rt s T..incici hz. (TA- . An convactors and subcontractors are required to be
Contact n ameC04 E,. c.45nor 0,3. 3. Arc1
4
licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: % SOO ije I Aill SU% S50 jurisdiction in which work is being performed. If the
City/StatelZIPfeertA,10 • 91-WZ--- applicant is exempt from licensing, the following reasons
, apply:
Plicine 214 - Crl 1 1 I Fax : /Ep3) 15 .- 3014 .
E-mail: (2
. F■40ar ,4_ . c..0"1
bac) ,:,::*.i r . j
Business name: - 05 0' !., r • .• ,. !:.. . I.EEEP,... . . .
Address:
Please refer to fee schedule
City/State/ZIP:
Fees due upon application
Phone: ( ) I Fax: ( )
Amount received •
CCB lie.: _
Date received:
Authorized signature: This permit applicadon expires ifs permit is not obtained
within 180 days after it has been accepted as complete.
Print name: I Date: • Fee methodology set by Tri-County Building Industry
Service Board.
Laasnerevrearr.pemaApp.doe IZto 440-46157111/02/COMMEM
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested c: J 7 AM PM =
Location / ,3 Wd Suite MEC
Contact Person C Ph ( ) cl PLM
Contractor l/ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing "7' _ '-yr\ A 0
Foundation ELC
F Drain Access:
Ftg Drain (3e-FX Z5? ELR
Slab Inspection Notes: SIT 2- -- (
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall —
Fire Sprinkler ( ,
Fire Alarm
Susp'd Ceiling n '/, flaWAVM
Roof �..P�C
Other 4-CY
WAY
PART FAIL 1
` ING
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 $ requir o next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call �r rein • section RE: t Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other
DO NOT REMOVE this inspection record from the job site.
S PART FAIL