Permit 1
CITYOFTIGARD
,% , DEVELOPMENT SERVICES SITE WORK
,44- '1I1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
PE RMIT #
PERMIT
SIT97 -0042
DATE ISSUED: 04/22/98
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PARCEL: 2S101AD -02600
SITE ADDRESS...: __1 SW 69TH AVE
SUBDIVISION • WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK LOT •031 JURISDICTION: TIG
CLASS OF WORK..:NEW PAVING? • Y RESO. NO.
TYPE OF USE •COM GRADING? Y VALUE...$: 85000
EXCV VOLUME: 0 cy LANDSCAPING?
FILL VOLUME: 860 cy SITE PREP? • Y
ENG FILL? • N STORM DRAINS ?...: Y
SOILS RPT REOD ?: N IMPERV SURFACE: 11024 sf
Remarks: Site work permit for the construction of a 2,964 square foot dental
office.
Owner: FEES
MCCROSKEY, DR. JOHN type amount by date recpt
14125 SW FARMINGTON PRMT $ 388.00 JD 11/07/97 97- 300780
BEAVERTON OR 97005 PLCK $ 252.20 JD 11/07/97 97- 300780
SPCT $ 19.40 JD 11/07/97 97- 300780
Phone #: EROS $ 80.00 JSD 04/22/98 98- 305162
ERPU $ 26.00 JSD 04/22/98 98- 305162
Contractor: ERPC $ 26.00 JSD 04/22/98 98- 305162
M STEARNS CONSTRUCTION CO WOUN $ 1210.97 JSD 04/22/98 98- 305162
8030 NE CLACKAMAS ST FIRE $ 155.20 JSD 04/22/98 98- 305162
PORTLAND OR 97213
Phone #: 256 -5502 $ 2157.77 TOTAL
Reg #.. : 44616
REL?UIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control
Tigard Municipal Code, State of Ore. Specialty Codes and all other Excavat ion Insp
applicable laws. All work will be done in accordance with Fill Inspection
approved plans. This permit will expire if work is not started Grading Insp
within 180 days of issuance, or if work is suspended for more St r m Drain Insp
than 180 days. ATTENTION: Oregon law requires you to follow rules San Sewer Insp
adopted by the Oregon Utility Notification Center. Those rules are Domestic water 1
set forth in OAR 952 -0014010 through OAR 952401-0080. Your may M i sc. I n s p e ct i on
obtain copies of these rules or direct questions to OUNC by calling Final Inspection
(503)246 -9187.
Issued by: , Permittee Signature: 0 '
O
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + ++ + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
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•
" N'- I 1 71 1 4/ 1
rdTY OF TIGARD I c C-
Site Permit Application 17:/) ����
13125 SW HALL BLVD. Commercial: Complete ENTIRE form fa:
TIGARD, OR 97223 Residence: Complete SHADED areas - 211 - t7 - bD L.(7
(503) 639 -4171 x304 .'/
Print or Type //�� "-o,� --
Incomplete or illegible applications will not be accep;f� ,,,_s c"°
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(Soils report required for >5 000 cu. Yards !�4i ! <4 s ! ; that 1 a i4fit! ti :e ::`s > : >
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Soils re ort re uired for >5,000 cu. Yds.
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(Engineer re uired if answer is
Retaining structure? (check one) ❑Rock ' FOR OFFICE USE ONLY
❑ pfvIU Notes: •
oncrete
❑Other
Total new impervious area including all � Land Use as ,�} Map/TL#
buildings, sidewalks, and paving //, £ 24' Sq. Ft. 7 /� `l/"
siteapp.doc9 /97 /A
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(:'OMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
DISTRIBUTION TO PLANS OUT TO DST
EXAMINERS (Note a.)
TYPE OF SUBMITTAL TOTAL CPE PPE EPE CPE PPE EPE
SITE 1 1 -- -- 3 (j,o,u) -- --
B (Newgt Add) 1 1 -- -- 3 (j,o,w) -- --
F (New or Add or Alt.) 3 3 -- -- 3 (j,o,f)
M (New or Add. or Alt) 1 1 -- -- 2 (j,o) -- --
B & M (New or Add) 1 1 -- -- 3 (j,o,w) -- --
P (New, Add. or Alt) 2 -- 2 -- -- 2(j,o) --
B & M & P New or Add.) 2 1 1 -- 3 (j,o,w) 20,0) --
E (New, Add, or Alt) 2 -- -- 2 -- -- 20,0)
B & M & P & E (New, Add) 3 1 1 1 3 (j,o,w) 20,0) 2 (j,o)
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NOTES: KEY:
a. Before returning to DST, Plans examiner gets appropriate j = Job B = BUP
number of revised plans from applicant, stamps and completes, o = Office M = MEC
updates and adds actions. f = Fire P = PLM
u =USA E =ELC
lead ed.: >d::AL" :::sib : : :>::::>:::::<:>::>:<:::>::»::>::::::> :::::: >:: :«: >:::: >:::: >::: » >: = = ..............................:..............;;::.;: �::::::::::::::::::.;::;::.;;: �t&< c�� w Wash. County F FPS
c. FPS is a new permit category set aside for fire sprinlders and fire alarms.
d. Effective August 15, 1997, Tualatin Valley Fire and Rescue no longer requires a set of
approved plans to be forwarded to their office.
Exception, continue to forward a copy of approved fire sprinkler and fire alarm plans with
calculations. l�1� C6
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