Permit 4 ., ', CITY ' SITE WORK PERMIT
i DEVELOPMENT SERVICES PERMIT # : SIT2004 -00021
�f �,�4 DATE ISSUED : 2/11/2005
,. --') 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: �� 7S PARCEL : 2S102CB -02800
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING : C -G
BLOCK: LOT: 021 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 88,000.00
EXCV VOLUME: 274 cy LANDSCAPING ?:
FILL VOLUME: 84 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT READ ?: IMPERV SURFACE: 15,900 sf
Remarks: New 9900 SQ FT office building. Credits for 3 dwellings
Owner:
FEES
KAMELIA MASSIH
1831 SW DICKINSON LANE Description Date Amount
PORTLAND, OR 97219 [BUPPLN] Pln Ck -Valu 6/22/2004 $441.13
[FLS] FLS Pln Rv 6/22/2004 $271.46
[BUILD] Prmt Fee -Valu 2/11/2005 $678.66
Phone: [TAX] Valu 8% State Stu 2/11/2005 $54.29
Contractor: [ERPRMT] Erosion Cntl 2/11/2005 $80.00
[ERPLN] Ersn P1ck - CWT 2/11/2005 $26.00
OWNER [EROSN] Ersn Plck - COT 2/11/2005 $26.00
[WQUANT] Wtr Quant ° 2/11/2005 $1,650.00
Total $3,227.54
Phone: 503 - 475 -3180
Reg #:
REQUIRED ITEMS AND REPORTS
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:
Permittee Signature: L/ /
- .ii
Cali (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
tM55lif o FFice 04,06-,
J Ooo JW Mc /F/c Hwy
iSite Work
j i i (ding Permit Application FOR OFFICE USE ONLY
' �ity Of Tigard DateB /O z; y 1� r �J/ /
t Permit No.: : ,9J , /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
DateB : Other Pern,it�a(�0 0000/
Inspection Line: 503.639.4175 • F' Date Ready /By: lure: El See Page 2 for
, ..
Internet: www.cl.tlgard.or.us _ . - . , Notified/Method: 776 Supplemental Information
TYPE OF WORK 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- family dwelling Commercial /industrial Valuation: $
0 Accessory building ❑ Multi - family Number of bedrooms:
A ❑ Master builder 1 7 5 /I e ; – Number of bathrooms:
JOB SITE INFORMATION AND L t ATION Total number of floors:
Job site address: _ New dwelling area: square feet
2 City/State /ZIP: IA a a Ci t OK 1 ri 'j z art( ,3 Garage /carport area: square feet
Q Suite/bldg. /apt. no.: J Project name: P a rt( 71 �I _ Covered porch area: square feet
= 7 ) Cross street/directions to job site: 5 k) )Ptij 111 _, HU] y q 1 Deck area: square feet
v Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
4,:j Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
\P.1 DESCRIPTION OF WORK work indic ed on this application.
If 0 k66( C-rt 0 I [ f c lor,61 etiv v 3 Valuation / /
Existing building area: 34 square feet
New building area: / 9 d / square feet
PROPERTY OWNER ❑ TENANT Number of stories: 7...--- Name: 1 i Q � h l L L G Ka m e l is Ma SS i I� Type of construction: 5 N
' Address: F 0. % dX 1 , 0 2 Occupancy groups: 3
� City/State/Z[P: c1 7
�+ �."..v ( ,(1-on Q g 2l // - (C //�� Existing:
Phone: (5' 3 ) 524 (p - `i Fax: ( 503 (D 4 4 —' 3 3 0 New:
• ❑ APPLICANT ❑ CONTACT PERSON — NOTICE
3 Business name: ,L E....--- All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: apply:
PP Y:
Phone: ( ) I Fax: ( )
E -mail:
CONTRACTOR
Business name: LL V k) ,/ n 1 tit, / , BUILDING PERMIT FEES*
Address: 12.0. 0 y (An Please refer to fee schedule.
-- City/State /ZIP: 13'Q liL� c r+0 11 e O tZ _ lI d l C P PP 7/ ,2 , S9
c6, V /� G l t t f _ Q 2 Fees due upon application
1.. Phone: (463) % 2.,,t, t, A ( " I Fax: (W3) ` (! 3 7
Amount received
Date received:
Authorized signature: /' / _ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Kam e( (c.- M Q S4 ) Date: 6'21.104 * Fee methodology set by Tri-County Building Industry
Service Board. L�
i:\ Building \Pemtits\SIT- PermitApp.doc 12/03 440- 4613T(II /021COM/WEB) da/' /5L/11 / - /' /`3
/.."-:-:4 S PZ 7/ • 4/6,
a : a
City of Tigard: Site Work Permit Checklist " ∎r t
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
❑ 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
i:\Building\Forrns \SIT - Checklist.doc 12/29/03
CITY OF TIGARD ;: sir
BUILDING DIVISION PERMIT #: ,pvv ei - 000 a.1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 " P4/14 2(O y -- - Z
Inspection Requests (24 Hrs.): (503) 639 -4175 "''.I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ? 9 75 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 —(& '"Oco Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 3S 34C C � --3 (4-5
1Q o . ‘ m 64s
Corrections /Comments/ Instructions:
Pit) v At J a y r ' - -
1 -i e,
n PASS NI PARTIAL APPROVAL fl CANCEL NO ACCESS
FAIL 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: in Vi Date: 1)/ C../01. Phone #: (503) 718-
CITY OF TIGARD s � 7
BUILDING DIVISION PERMIT #pO � f --0 2-I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 *et ,,,
Inspection Requests (24 Hrs.): (503) 639 -4175 Ai 67 �! 'L/ aZ o ;)
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 7 S _a CLASS OF WORK:
SUBDIVISION: #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 " Pour Time:
Code # Inspection Description Confirm # Contact # Message
sy 3 'ILO 7 -3y5
Corrections /Comments / Instructions:
A,. A n p .r6 -=.t . P1 g,,, -` Pr T 3 b
I F N1 6, Lk � . . , e Oz I Z -A, r v — �— ✓vvtl�Jl. P CB S duj" +�i r�
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4 iri atst.l ✓ Of.r. 14 €1 N:v tt La t - : ��, {� 0
!U r, J s/ .1L' r ��- �ct,-�<6.4..
n PASS PARTIAL APPROVAL n CANCEL n NO ACCESS
r..); L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: b twt,i \V v4)= - -•-- Date: ;lyti v Phone #: (503) 718 -
OF TIGARD 24 -Hour jr-/ ZC0(1– CCC)Z4
BUILDING Inspection Line: (50 ?) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested Z /�' `4" AM PM BUP
Location i .- Tr z. kd� G3 Suite G MEC
Contact Person Ph ( ) �8� - :1 � j PLM
Contractor 1 Ph ( ) SWR
BUILDING Tenant/Owner \� ` \ At (.i ( t.w ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain '
Slab Inspection Notes: z oS — ` CO ,6 0 L/ - DU
Post & Beam
Shear Anchors // /1/e/ 7 OA) j 1 ? / T, cv ? ''L// 1/ .- HO L_/)
Ext Sheath/Shear r
Int Sheath/Shear /A _ 6)71 cL G r 2 1/4, :-` ' ' Al G1 -'� P \'.�
Framing /�
Insulation / �- -� L. 5 1 ( e S > ��
Drywall Nailing ` \ /
Firewall W ( A ) r'j L� Zc 04-i - C1 v _ 7 .2 - S TZ ,2c. c F iy2 tl Y . ce
Fire Sprinkler \
Fire Alarm ( A- S) (Z .Z.-) U '-/ - 0 U 6 CJ I // 7 /C$": 00
Susp'd Ceiling /
/
Roof ( 2 ) Z 6 "Zv0Li - 000 '-fg ; Y.�L1f Rj• Gl e,✓1vr)4 {&_
Other: _ _ /
Final ( S - 1*- ) S 1 ZC. )0y- UQ)2 / --€:--
PASS PART FAIL / /
PLUMBING � l 1 /j Lc �0 U S - - D D D / S I) i 4)1 C; / t S Gi --e
Post & Beam C
Under Slab Z�v _ 0C/0 //
Rou h `-1 P� 2/ <-7) %' / - 0 C - 00 U 1 ? ii -
Sanitary Sewer ( N) ' - 2_ o ii - 00 Z C / "1 l /l L /� 0/0/, 2f/
Rain Drains v " )' mil � i
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: // S �v L.J G /c v 2e
Final /% �' �/�
PASS PART FAIL
MECHANICAL ". -
/ Gt C C - //
Post & Beam � •
Rough -In
Gas Line
Smoke Dampers /
Final C, -_() ( )-) /c,:1 p -ef �_ r ;�L� . �0 ci` GO V/ �
PASS PART FAIL / 'l
ELECTRICAL �N' + /40 Z- /) /, S7/.. -2 S ( / O / D . 2 7 1) Gi..t' ,
Service
Rough -ln �-
UG/Slab -�
Low Voltage <77/., _ f
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_WS PART FAIL
(gip ❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line ` . ,
ADA �/ /�'�� — -
-
Approach /Sidewalk Date /) � ' Inspector Ext
Other: i� ________
Fi alb , 7 , DO NOT REMOVE this inspection record from the j;.ab site.
.pApS /PtAR7/ ' Ft17 L t.,,,
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (593) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested 2 f -� `i- AM PM BUP
Location ' 9 - 75 rz L G Suite MEC
Contact Person Ph ( ) 9 :? j `-S PLM
Contractor 1 Ph ( ) SWR
BUILDING Tenant/Owner. 0 1 `x ' -55 1" T' C-- 6LA.A l Aw'n ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain G 0 L/ • 60 0:9
Slab Inspection Notes: 2 . j 0s- c v IT�
Post & Beam
Shear Anchors ''/JQ j C.)A J S 1 T / 73L cif" I L/`/ 'i A-/ LL
Ext Sheath/Shear
Int Sheath/Shear A t 6, -\ G T
Framing A � Gi` "' I 0,e2 ,f,.., v � S _. *:- ✓ti'1 Gl S-� Z.v�'- ,rv.'`"
Insulation ��_�- z * vL5) ` ( `42 e S - 01"-Q-
Drywall Nailing Al
Firewall A ( A ) r; lA Z.O y 00 - ,- 5 -- (-- 7 . :a 7 - > 2c G' F i yZ 1-4 . G,�
Fire Sprinkler \ /
Fire ; �
Alarm g � - -) S R 7 O L i - 0000 I // if 7/ 0S: 0 0
Susp'd Ceiling _ / /
Roof ( �) LN6 "2- c.) Yr2
04 - 6 Sf.rzf ( y - -
Other: _ _
Final ( ) 57- / 2-0 0 L-/ - 0062- / -E3
PASS PART FAIL - yu.�,�.r
PLUMBING CT- ) Li,--f 2U U j - 0 0 D / S / 1 ,' - )1 D /742 c S Cu -- -d
Post & Beam ( ) I
1 /'L td �/U �� f ' /�
Under Slab - U U CU 1 -€--
WatehService (5 ) ;/ (9 2 /./ 0 0 1 - U0 o l 7. � ---&--
Sanitary Sewer ( )4 ) j 2-e 0 ii--- (, w Z � "� ) l / 1 A
Rain Drains ,-)C �/ G L. ! �/ l 7, ( / ���, Z�
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: // L 7� T
Final S ---- / — l J L" lJ 0-ye `"c v /) e" f
PASS PART FAIL // 412 C j/
MECHANICAL /
Post & Beam
Rough -In
Gas Line
Smoke Dampers 7� �� )/ (/
Final . /4-
c � -- ! L i f 2,1 -0 0 - dO 7 l �'
PASS PART FAIL / �c�
ELECTRICAL �/�' " iI 0 L 1) '' c----,6,t S (,U /?' / 0 / 0 . Z 7 ) 6 (k .
Service
Rough -In
UG /Slab �-
Low Voltage -� ; ,(-- 7 U
Fire Alarm '�
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
(KO 0 Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line _
ADA / / \ /' ! _ / _ " L: .y
Approach/Sidewalk Data r Inspector J Oct
Other: � j..‘2- - •
Final ,�1 ,, / DO NOT REMOVE this inspection record from the job site.
','Fit ,st, ' PART %'