12950 SW BULL MOUNTAIN ROAD-1 12950 SW Bull Mountain Road
CITYO F TIG ®® SITE WORK PERMIT -
DEVELOPMENT SERVICES PERWT# : SIT20t)0-00042
13;25 SW Hall Blvd.,Tigard, OR 97"23 (503) 639-4171 DATE ISSUED . 8/25/00
PARCEL : 2S109AD-01400
SITE. ADDRESS: 12950 SW BULL MOUNTAIN RD
SUBDIVISION: ZONING : R-7
BLOCK: LOT: JURISDICTION : URB
CLASS OF WORK: OTR PAVING ?: RESO. NO:
Yr-F OF USE: SF GRADINr 1: VALUE: $2,000.00
EXCV VOLUME: cy LANDSCAPING?:
FILL VG_UME: 600 cy SITE PREP ?:
ENG FILL?: STORM DRAINS?:
SOILS RPT READ?: IMPERV SURFACE: sf
Construct a noise berm of 600 cubic yards of fill.
Owner: r _FEES` ---
BARTLETT, JACKSON CURT13 Type By Date Amount Receipt
12950 SW BULL MOUNTAIN RL -
TIGARD, OR 97223 PLCO CTR 8/25/00 $32.50 27200000000
PRM5 CTR 8/25/00 $50.00 27200000000
5PC� CTR 8/25/00 $4.00 27200000000
Phone:
Total $86.50
Contractor: ---
OWNER
Phone: 579-9125
Reg#:
Required Inspections
Final Inspection
This permit is issued subjec"o 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 mr re than 180 days. ATTENTION Oregon law
requires you to follow rules adooted by the Oregon Utility Notifi aticn ;enter. those rules are set forth in OAR
952-001-0010 through OAR 95 -001- 90. Yo ma 0 ai t these rules or direct questions to OUNC by
calling (503) 246-1987. ----.---
Pern.ittee Signati e:
Issue((5o4175
y
Call by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARDSite Pe,-mit_App4GaUQri Plan
13125 SW HALL BLV O. Cormm ,rciai,Residential
�-- Date Rec'd
1 ,CARD, OR 97223: - and Multi-Fames Date to P.E. 0
(503) 639-4171 x304 Date fj DST Si 4K-eG
Pvrmtt# Sit'Q/t'b -6eVt7r
Print or Type Related SWR#
Incomplete or illegible applications will not be accepted 1i°ed
Project Name Utilities(Complete all that apply)
Job AJOISF- ----
Address Address _ Storm Sewer /
- -- J aao 's-0, Ektie a) --- -- --- — Clnear Ft.
Name Sanitary Sewer
.11" Linear Ft.
Owner Mailing Address Fresh Water
Adyirni,l 1 mn Llnc at Ft.
Cit /State Zip Phone Catch Basins
(0 P, y?.�A (2 -Y?T #
General Name Clean Outs
Contractor C Uj Q £ (1— #
Prior to pernit Mailing Address Describe work to be done:
tcopy a all El NewQ Addition❑ Alterationo Repair
licenses are City/State Zip Phone Additional Description of Work:
required N (70 AJ d7/2[!O 1—
expired In COT State Const.Cont.Board Lic.# Exp. Date �� ` C�~�
database
Name Project �-
_ Vai:Mlon $ `ate
Architect Mailing Address Plans Requue-I• See Matrix on back page
- The following,must ac(.;Vmmanv 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 - T Erosion Control Plan and Retaining Structures
details Including calculations
City/State lip Phone Site Utility Plan and details Solis Report
(showing connection to (If required)
_
approved system)
Excavation Volume I hereby acko-hedge that I have read this application,that the
Information given Is correct,that I am the owner or authorized
cu.yds. agent of the owner,and that Ian:;submitted are In compliance
with Qregon State I s.
Grading Volume Sig tura er/ g t Date
(Solis report required for>5,000 cu.Yds,)
cu.yds' _ -
Fill Volume on act Personame Phone
(Fill exceeding 12"in depth shall be compacted
To 90%of Maximum Density) - �
Retaining structure?(chock one) Rock FOR OFFICE USE ONt Y
El CMU Notes:
❑Concrete
❑Other
Total new Impervious area including all Land Use Case# Map/TL#
bulldings,sidewalks,and pavingSq.Fl.
a � t L� jQ •C U
CITIr OF TIGARD I �+
COMMERCIAL SITE WORK PERMIT
i-\dstslf,rms\slte-app.doc 3/17/00 LA "-r)R ! �r
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VISUAL CLEARANCE AREA FOR LOTS WITH
DRIVEWAYS 24' OR MORE IN WIDI 'l , AND FOR
CORNER LOTS WHICH ABUT PUBLIC; STREETS
24' OR MORE IN WIDT! .
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i—VISUAL CLEARANCE-- AREA
PROPERTY LINE �y
SID�_VVN:_K
- , -- GREEN STRIP �'�-_--____._
30 �--�
•F_���'` PUBLIC STREET OR DRIVEWAY --- -''
LEARANC"PE AREA 1='OR DRIVEWAYS
VISUAL_ C , .�-�-
LESS THAN 24' ii•JI WIDTH.
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I �----BUILDING SETBACK LINE
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VISUAL CLEARANCE AREA
30'
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I APEX
PRI VAT'E ACCESS
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