Permit (113) r
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CITY OF TIGARD SITE WORK PERMIT
461‘ 11( 0 1 - 4 . DEVELOPMENT SERVICES PERMIT #: SIT2002 -00038
.. 13125 SW Hall Blvd., Tigard, O R 912 (503) 639 -4171 DATE ISSUED : 3/14/03
SITE ADDRESS: 16200 SW PACIFIC HWY � � ' PARCEL : 2S115BA -00101
SUBDIVISION: TIGARD TOWNE SQUARE „ 1 , I ZONING : C -G
BLOCK: LOT: 001 JURISDICTION : TIG
CLASS OF WORK: PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 40,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Phase I, Lease A, Site work: 8000 square foot addition to existing shopping center.
Owner:
FEES
BIT HOLDINGS LTD PARTNERSHIP D
BY FORUM PROPERTIES INC Description Date Amount
FIVE CENTERPOINTE DR STE 290 [BUPPLN] Pln Ck -Valu 12/30/02 $257.27
LAKE OSWEGO, OR 97035 [FLS] FLS Pln Rv 12/30/02 $158.32
[BUILD] Prmt Fee -Valu ' 3/10/03 $395.80
Phone: [TAX] 8% St Tax -Valu 3/10/03 $31.66
Contractor: Total $843.05
MT HOOD LAND DEVELOPMENT INC
P.O. BOX 1432
SANDY, OR 97055
Phone: 503 - 826 -1412
Reg #: LIC 88843 •
Required Inspections
Erosion Control Insp 846 -8444
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 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -6699.
Issued By: �O
Permittee Signature: /�L•�� %"�'_' -�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
,, Site Work _ - - ��
Build 'ermit 1 �ori FOR OFFI USE ONLY
Received , /0 p y Building GG�� •
j Date/By: Permit No.5/ / 09.04 ` - 'C&
City of Tigard Planning Approval
Date/By: Ot Date/By: Permit No.:
13125 SW Hall Blvd. DEC 3 0 2002 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: ,
Phone: 503- 639 -4171 Fa i1Tg3C98Z1 D / /i. `�' 'c Post - Review Land Use
Internet: www.ci.tigard.o8UlLDING DIVISI •:_: I Date/By: Case
No. 00ge -C l �D
'' Contact Juris.: ® See Page 2 for
- 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
PJ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION • Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling - gj Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 1 <02.99 S1Y PaUFI 4 - Hwy New number area ea (sq
y New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: 19. T — rlchlb dea TB VYI+t Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
\PES aF-J -�hH Q b 09 RD COMMERCIAL T' USE CHECKLIST
Subdivision: I Lot #:
Tax map /parcel #: ZS I , 15' 8,4 Til►7t L, 10 ( 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, materials, labor,
overhead and profit for the work indicated on this application.
Gar est 21 - 122.4 <r 1 2 S' ` e l (.Ot".
. ..xic lac s Valuation $ 4-Q occ) ,
Existing building area (sq. ft.) C,
New building area (sq. ft.) rg �O
Number of stories
----. 'is0 PROPERTY OWNER I ❑ TENANT Type of construction 1- N.
Name: S M I KVp-ot11/ymtkp LL—c- Occupancy group(s): Existing: I+CI
New: KI
Address: (I 21 S \y Sac.-rna t-i , SLf 1-re 1-0
City/State/Zip: fa•e'i4e14,3=. , c' Q ,, °YZ 2-46
Phone: 2L-Z°> Fax: Z'j ¢r'?199j 3 NOTICE: All contractors and subcontractors are required to be
IA 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: s'( \ ,p kAlze.4,3 rts= jurisdiction where work is being performed. If the applicant is exempt
Contact Name: .$p{P a ,...i,s from licensing, the following reason applies:
Address: X77 S s\\I 11 I ltw /a r
City /State /Zip: -,, r Ar , szis'l ,
Phone: (944- -¢•222 I Fax: Iv - ^a 6 67 BUILDING PERMIT FEES*
E -mail: 11 448 t [` ` C> . Please refer to fee schedule.
CONTRACTOR
Business Name: Mt //oaf( 'A-04)/ 4- Fees due upon application $
Address: PO a o- /4/3 2
City /State /Zip: 02 9 ?OO. Amount received $
Phone: s a3- g a 6 —/ '-ii 2 Fax: S o3 Aga b - iyo3 Date received:
CCB Lic. #: g$ W3
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 3- /O-a3 180 days after it has been accepted as complete.
FliZ A N k ..Jo /../it S 0 co *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
- r'.: 1 5q4.• if 0 Tat -o 6 1. 6 6
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
Pi. AV 247.'21
Fats 168.32.
■
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•
SITE WORK PERMIT CHECK LIST
Commercial, Multi - Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: 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) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other
❑
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft. _
Site Utilities Plumbing Work:
Complete the "TAN" Plumbing Permit Application for site utilities plumbing work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attach ed. 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.
# of Plans
TYPE OF SUBMITTAL 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).
i:\dsts\forms\sitechecklist.doc 09/24/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - A5.. AM PM BUP
Location I lh' a D l� Y Suite / Z MEC
Contact Person Ph ( ) qq g D 76 O PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain Sir OD 63(5
Slab Inspection Notes:
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
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 $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
- upply Line
ADA Date / 2-7 U3 Inspector Ext
Approach/Sidewalk iP
Other:
DO NOT REMOVE this Inspection record from the Job site.
qAMS) PART FAIL