Permit CITY TIGARD SITE WORK PERMIT
r� DEVEL SERVICES PERMIT # : SIT2000 -00014
1
�II DATE ISSUED : 06/12/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL : 1 S136DB -02600
SITE ADDRESS: 11201 SW 72ND AVE
SUBDIVISION: ZONING : C -G
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: $75,000.00
EXCV VOLUME: cy LANDSCAPING ?: Y
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: 18,000 sf
Remarks: Site work for additional parking lot to existing restaurant.
Owner: FEES
MCDONALD'S CORPORATION
LOY TAYLOR Type By Date Amount Receipt
5000 SW MEADOWS RD #200 PLCK DEB 04/13/2000 $356.04 1417
LAKE OSWEGO, OR 97035 FIRE DEB 04/13/2000 $219.10 1417
PRMT KJP 06/12/2000 $547.75 0002850
Phone: 684 -9334 5PCT KJP 06/12/2000 $43.82 0002850
Contractor: EROS KJP 06/12/2000 $80.00 0002850
ERPU KJP 06/12/2000 $26.00 0002850
STOLLE CONSTRUCTION INC ERPC KJP 06/12/2000 $26.00 0002850
PO BOX 61748 WQUN KJP 06/12/2000 $1,977.27 0002850
VANCOUVER, WA 98666
Total $3,275.98
Phone: 360- 906 -8142
Reg #: LIC 131189
Required Inspections
Erosion Control Insp 844 -8444
_.Grading
Paving Insp
Strm Drain Insp
Culvert/Catch Basin
Final Inspection
L( py
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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signature: )( 4100 -
Issued By: /
- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4.
11
• •
C ITY OF TIGARD Site Permit Application Plan Chec <i
13125 SW HALL BLVD. Commercial, Residential Rec'd By
Date Rec'd — 13 - 21) , D
TIGARD, OR 97223:: and Multi - Family Date to P.E. y - a/ -ae
(503) 6394171 x304 Date to DST s1Zz1 dbfir
Permit # 6/To?aaa -DGG /V
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Project Name Utilities (Complete all that apply)
Job M rpovIALDS PA2Kllyi Ler r c l`1 W
Address Address 11101 641 41.11 Storm Sewer
SW F. r T1 Z AAD 5 Linear Ft.
Name Sanitary Sewer
PO D0144.D eaRPb flot4 1 Lo Y ray Lao. • ' 0 Linear Ft.
Owner Mailing Address Fresh Water •
5 000 5W IAEADo\,V, RD ._ t 4. Zoo 0 Linear Ft.
City /State Zip Phon Catch Basins
CAKE osw1✓Go 9735 444 - ci334 # 1
General . Name /„. f Clean Outs
Contractor - � c,i if ., 110 vi bT ru c. /o,n 4174, • # O
Prior to permit Mailing Address Describe work to be done:
issuance, a n 0� New❑ Addition Alteration❑ Repair
go. U
copy of all /1 , h� 6 / 7 � ❑
licenses are City/S � YY// Zip 21( Phone Additional Description of Work:
required if Vu,✓1 CO4 kik/ LOS' 3c,n Wil
expired in COT State Cogs o t Bard Lic. # Ex1D3/ i G o I
database I 111 �� `"'�� L7 1 UNf^ (PT uC- �laTlhLc-1
Name .Project
ER f4E9IT Jo`(n1Ea , WV.% Mott'tc -T'S Valuation $ IS'
Architect Mailing Address Plans Required: See Matrix on back page li r
14 SC '(E 4T1A AVE The following, must accompan this applicatio
City/State Zip Phone Site plan with Vicinity Map Parking (including
Q i ost 97.21 o 233 -s454 Showin• ADA com•Iiance ADA & Lighting Plan
Name Grading Plan and details Landscaping Plan
WEsiEc44 £KG . 1 MIKE fo1sSA,rr
Engineer Mailing Address Erosion Control Plan and Retaining Structures
3$44 FAl2VIEW IND . .DR. 5E• 1' 1o0 details including calculations
City/State Zip Phone Site Utility Plan and details Soils Report
SALEt l 473 S'S - 2474
(showing connection n to (if required)
o approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
information given is correct, that I am the owner or authorized
0 cu. yds. agent of the owner, and that plans submitted are in compliance
• with Oregon State laws.
Grading Volume . Signatu e of Owner /Agent Date
(Soils report required for >5,000 cu. Yds,) 1 °O
4 1-100 cu. yds. {Cl
Fill Volume Con a e on Name P 3111.3 one j _
(Fill exceeding 12" in depth shall be compacted
To 90% of Maximum Density)
± 4 5o cu. yds. E1.44E-E 1 Jeyr4E4 233 -$ 4
Retaining structure? (check one) ['Rock FOR OFFICE USE ONLY `
❑ CMU Notes:
Cb I`b ) ['Concrete
r Other
•
Total new impervious area including all L nd Use Case # Map/TL#
buildings, sidewalks, and saving 1 di Sq. Ft. 7 /Z-" r �* -00Qa 7 �-
o ,, 2 1 1/f .-/L /
CITY OF TIGARD Q ' ' 1. U �� 1 �
COMMERCIAL SITE WO PERMIT � I I FU A) — �{6),'i9LI 6 1) c51/
• i.\dsts \forms\site- app.doc 3/17/00 a ty 1 , . ' //'" F-L12 -- -A01, 1 0
149 9-15.1q