Permit C ITY OF TIGARD SITE WORK PERMT
COMMUNITY DEVELOPMENT PERMIT # : SIT2007 - 00026
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TIGARDr 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED : 3/26/2008 PARCEL : 2S102CB - 00100
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SITE ADDRESS: 12850 SW GRANT AVE ZONING : R -12
SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION : TIG
PROJECT: BROADWAY ROSE THEATRE CO
Project Description: Regrading & paving.
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CLASS OF WORK: OTR PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 0.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT REQD ?: IMPERV SURFACE: sf
Owner: FEES
TIGARD TUALATIN SCHOOL DIST. #2 Description Date Amount
6960 SW SANDBURG ST [BUPPLN] Pln Rv -Valu 8/17/2007 $497.55
TIGARD, OR 97223 [FLS] FLS Pln Rv 8/17/2007 $292.58
[BUILD] Prmt Fee Yalu 3/21/2008 $765.46
Phone: [TAX] Valu 8% State Surcharg 3/21/2008 $61.24
[ERPRMT] Erosion Control 3/21/2008 $80.00
Contractor: [ERPLN] Erosn Pln Rv CWS 3/21/2008 $26.00
[EROSN] Erosn PIn Rv COT 3/21/2008 $26.00
ROBERT GRAY PARTNERS INC
12705 SW H ERMAN RD Total $1,748.83
TUALATIN, OR 97062
Contact #: PRI 503 - 692 -4675
FAX 503 - 692 - 9292 REQUIRED ITEMS AND REPORTS
F,02 /O AJ i 74
Reg #: LIC 65424
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 OU NC by
calling 503.246.6699 or 1.800.332.2344.
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Issue By: /� / ��� Permittee Signature: ma
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Site Work (Z LO & t JT
Building Permit Application RECEIVED Received I FOR OFFICE USE ONLY
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City of Tigard Date : �7 07 • Permit N , t _ ap p 2_ 000- i
13125 SW Hall Blvd., Tigard, OR 97223 Plan B
RevimOppnlipa .,
Phone: 503.639.4171 Fax: 503.59 00 2007 Date /B : �illl �� Other Permit:
TIGARD Inspection Line: 503.639.4175 �I Date Ready : : Juris. El See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: 7 Supplemental Information
• TYPin v)80 DIVISION -
REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
* Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- fancily dwelling RI-Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 44522 5. , N
� New dwelling area: square feet
City /State /ZIP: 774,412 / O 7223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: (,D4,04 V 4 y < F Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: #ZCV Permit fees* are based on the value of the work performed.
Z �/� G Indicate the value (rounded to the nearest dollar) of all
T.ax map/peed-no.: equipment, materials, labor, overhead, and the profit for the
Nov
DESCRIPTION OF WORK work indicated on this application.
! wog r .1. ��e f o � , IN mew � ��l Valuation: $ 141 , �/
K/ � buildin area: square C /A/4 g 1.404/ Existing building * uare feet q
New building area: 3 fa square feet
❑ PROPERTY OWNER TENANT Number of stories: I �vv
Name: IM/ON V �/f 40417 Type of construction: 3 -4
Address: r . 0. ' ill) 2 3/04 Occupancy groups: A � 1
City /State /ZIP: V i OP. 9 728/ Existing:
Phone: ( j5) 6�3Z? Fax: (503) 67og /2 New:
❑ APPLICANT 21 CONTACT PERSON NOTICE
Business name: 5 �jy' �f,( rre rs- All contractors and subcontractors are required to be
Contact name: /1 !iC/� 5A444, ��' 111 "' ��` licensed with the Oregon Construction Contractors Board
/'l T . under ORS 701 and may be required to be licensed in the
Address: / M V/,,) 4/AM POL/G1/� y6 7J7 // jurisdiction in which work is being performed. If the
City /State /ZIP: fit(
�de I �N / DA. ! 72 2 y ^ applicant is exempt from licensing, the following reasons
apply:
Phone: (f03) 2 Z _ !• /�'�1A7' Fax: : (�, z73-5,8,/
E-mail: J7 O . CO/
�7f CONTRA O R
Business name: kr Y H4 - A_V26 /),jC BUILDING PERMIT FEES*
Address: /2 70 , 6 - `. (i y/...mJJ /2 (Please re(er rofee schedule)
Structural plan review fee (or deposit): e/9 7 . S
City /State /ZIP: -7 4 r, ,$) p 2. 706 9, FLS plan review fee (if applicable):
Phone: ( 05 ( 4 ' zu, 75 Fax: (505 LO q9_ _9 i'9.....
CCB lic.: ( L f Total fees due upon application
Amount received: . ‘._, j
Authorized signature This permit application expires if a permit is not obtained
/� within 180 days after it has been accepted as complete.
Print name: Tt i(,/ + u li , Date: 8�7/ * F ee methodology set by Tri- County Building Industry
bf ill e4 �_rY� / // Service Board. O /3
l: \Building \Permits \SIT - PermitApp.doc 06/26/06 440-4613T(1 I /02/COM/WEB)
City of Tigard: Site Work Permit Checklist
Page 2 - Supplemental Information
Commercial, Multi - Family and One- and Two - Family Dwellings:
No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will
not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If
fill is in a flood plain, drainage way, or wetland, the applicant must apply for a sensitive lands review
(SLR).
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 Plumbing Permit Application for site utilities plumbing work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attached. 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
LI Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
1:\ Building \Permits\SIT - PermitApp.doc 06/26/06 2
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: S!T2007 -00026
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3,r2ff20()0
Phone: (503) 639 -4171 �� %i
Inspection Requests (24 Hrs.): (503) 639 -4175 ,1. i,-:p'-''L
INSPECTION WORKSHEET FOR DATE: 1214/20t TIME: 7:00AM PAGE: 12
SITE ADDRESS: 12MM SW T GRANT AVE CLASS OF WORK:
SUBDIVISION: CI: TIGAI-RD ELEMENTARY LOT #: 041 TYPE OF USE:
PROJECT NAME: BROADWAY ROSE THEATRE CO
DESCRIPTION: Regrading & paving.
OWNER: TIGARD TUALATIN SCHOOL DIST. #23, PHONE #:
CONTRACTOR: ROBERT I GRAY PARTNERS INC PHONE #: 03- 697.4675
Inspection Request Scheduled For: Date: 12/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 0787188.01 503-793-8016 N
Corrections /Comments/ Instructions:
❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: `Z 66 Phone #: (503) 718- zzz--i