Permit CITY OF TIGARD SITE WORK
DEVELOPMENT SERVICES PERMIT
A-x PERMIT # • SIT97 -0013
13125 SW HaII Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 07/30/97
PARCEL: 15136DB -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...$: 180000
EXCV VOLUME: 6600 cy LANDSCAPING? • Y
FILL VOLUME: 4400 cy SITE PREP? • Y
ENG FILL? • Y STORM DRAINS ?...: Y
SOILS RPT READ ?: Y IMPERV SURFACE: :32010 sf
Remarks : Site and grading permit for McDonalds restaurant and drive -thru.
Owner: FEES
MCDONALDS CORP type amount by date recpt
5000 SW MEADOWS RD PRMT $ 0.00 DRA 05/01/97 97- 294035
STE 200 PLCK $ 0.00 DRA 05/01/97 97- 294035
LAKE OSWEGO OR 97035 PRMT $ 633.00 DRA 07/30/97 97- 297739
Phone #: PLCK $ 411.45
SPCT $ 31.65 DRA 07/30/97 97- 297739
Contractor:
ORDELL CONSTRUCTION CO
360 SHELLEY ST
SPRINGFIELD OR 97477 -5900
Phone #: 360 -735 -0075 $ 1076.10 TOTAL
Reg #..: 006303
REQUIRED 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 Excavation Insp
applicable laws. All work will be done in accordance with Fill I n s p e ct i o n
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 S t r m Drain Ins p
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 -001 -0010 through OAR 952 -001 -0080. Your may Reinforced c o n c r
obtain copies of these rules or direct questions to OUNC by calling Engineered gradi
(5831246-9187. Final Inspection
Issued by Permittee Signature . atO
11-/YKA-ki
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY•OFT Recd By � ,
13125 SW HALL BLVD. Private Grading, Paving, Site Accessibility Date Recd ,5 - / - 9 7
TIGARD, OR 97223 Retaining Structures, Utilities and Related Work Date to P E. 6 -S -4 17
(503) 639 -4171 x304 Date to DST
`
/ I Permit Si �j�
� Called
Print or Type b �� /
Incomp illegible applications will not be accepted � � ��
, , , lete r
Project Name Utilities (Complete all that apply)
Job Ake D oni A-Uj .
Address Address X1,0 (' C.I Flo kiGvy Storm Sewer
Linear Ft.
Name Sanitary Sewer
kit S CePp • IGO Linear P.
Owner Mailing Address Fresh Water
5oc�o �/ L'1. r -. 0 Ws 1 •,STt• 200 1 Linear Ft.
City/State Zip Phone Catch Basins
LAM tiIJo 91035 *3 6 &f - #
I General Name /� Crean Outs
`I p Q Qbi t .�, (' [) 1� `a -� # 4.
Contractor Mailing Address Describe work to be done:
(Prior to NewX Addition° Alteration° Repair°
Issuance _
aoolcant must City/State Zip Phone Additional Description of Work:
provide all
"DE.1/0..op A QUAD g160.4fe . V.f tae
all contractors State Const. Cont. Board Lic. # '
Exp. Date
license Willi- �t "POW. -'tsh2rk t's£.2Nrt� e_.
°n fO rrn aoon in COT Business Tax or Metro # Exp. Date
COT catacase)
! Name Project S
;11 UK, wroA,3 Valuation I e,o r Opp . I left, ococi
• Architect Mailing Address Plan Submittal: (3) sets containing each of the
i 111 3O12.4lc ' following, must accompany this application:
1 CityiState Zip I Phone Site plan with Vicinity Map Parking (including
OAle,e( Got. r ZL. (00524 le30-62-3 3(023'\ 1 Showing ADA compliance I ADA) & Lighting Plan .
Name ' Grading Plan and details l Landscaping Plan
M L Attisc
Engineer I Mailing Address Erosion Ccntrol Plan and I Retaining Structures
`1 I t �tQ..■ f� • ti vn • details including calculations
City/State Zip Phone S.te Utility Plan and details ! Soils Reoort
(showing connection to I (if required)
•
.0WeQoolc r ' rL. (c F21 (0 • 30-62 3 - 524fo I I approved system,
E.ccavation Volume : nerecy ackncwiec;e that I nave read this acplicatlon. that the
(Soils report required for >5.000 cu. Yards 6 6 ro Information given is correct. that I am the owner or authonzed
eigaK cu. yds. agent of :he owner. and that plans submitted are in compliance
with Oregon State laws.
:; Volume y / y v ; Sigr tur' G��
of ent Date
ells report required for >5.000 cu. Yds.) _ -J� I � �„ -01 -9]r
o cu. yds. -- j .� _ �/
`: the till support a structure Contact Person Na • e i Phone
;Engineer require if answer is yes) YES4X NO° ( � T i
a . 1684- `'i33.1-
Retaining structure? (cneck one) Rock FOR OFFICE USE ONLY
° CMU . ! Notes:
i °Concrete
'Other 4tF•
i
rc :al new impervious area including all ! 3,2 p,1 ' Land Use Case # I Map/T1.1
_u,idines. sidewalks. and paving I Sq. Ft. 7 11 6 1'7 — ODOR
csts
3/93 0 ^ 6
Permit # Account Description Amount Amt. Pd. Bal. Due
Build. Permit (BUILD) &53•
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT)
State Tax (TAX) .g1.4)5-
g/ •4)5 - 3 7.
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check
Build: (BUPPLN) 7//• 5 / / / / 1 . 4 1
Plumb: (PLMPLN) -
Mech: (MECPLN)
CDC Review (LANDUS)
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Commercial TIF (TIF -C)
Industrial TIF
Institutional TIF (TIF -IS) •
Office TIF (TIF -O) •
Mass Transit TIF (TIF-MT)
I
Water Quality (WQUAL) 6V1 7 \- Gthitur .1 -retz r l y .
Water Quantity (WQUANT) j�_ A. / -
Erosion Control Permit ( ERPRMT) ,.'/ hers rO� cr \ :TOO
Erosion Planck/USA (ERPLAN) ,A R �� - ���� a L. '
Erosion Planck/COT (EROSN) 2-6 . 6
Fire Life Safety (FLS) _
TOTALS: ,: )