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Permit S" • CITY OF TIGARD SITE WORK PERMIT I r A DEVELOPMENT SERVICES PERMIT # : SIT2000 -00018 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 6/9/00 SITE ADDRESS: 14795 SW 72ND AVE PARCEL : 2S112AC -02300 SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING : I -L BLOCK: LOT: 048 JURISDICTION : TIG CLASS OF WORK: OTR PAVING ?: RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: $30,000.00 EXCV VOLUME: cy LANDSCAPING ?: FILL VOLUME: cy SITE PREP ?: ENG FILL ?: STORM DRAINS ?: SOILS RPT REQD ?: IMPERV SURFACE: sf Remarks: retaining wall Owner: FEES C + C DEVELOPMENT BY DELTA FIRE INC Type By Date Amount Receipt PO BOX 4010 PLCK GEO 5/12/00 $192.73 0002120 TUALATIN, OR 97062 FIRE GEO 5/12/00 $118.60 0002120 PRMT GEO 5/12/00 $8.89 0002120 Phone: 5PCT SS 6/9/00 $23.72 0002826 Contractor: PRM3 SS 6/9/00 $287.61 0002826 OWNER Total $631.55 Phone: Reg #: Required Inspections Fill Retaining Wall /Footing Strm Drain ORIGNAL Final Report t En Eng'd Grading Final Inspection 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 ; -L ' _ -zLe Issued By: ��i i� / CaII (503) 639 -4175 by 7:00 P.M. f •'an inspection needed the next business day q .,< S ite Permit Application Plan - ck# 0-1_3 7C ...„ G.'�Y OF TIGARD PP keo.d :: _ � 13125 SW HALL BLVD. Commercial, Residential Date Recd � '- if TIGARD, OR 97223:: and Multi- Family Date to P.E. , g (503) 639 -4171 x304 Date to DST /VP 10 - Permit • Print or Type Related SWR # / ' - �. i " Incomplete or illegible applications will not be accepted Called - ►�. Project Name Utilities (Complete all that apply) Job Delta Fire,Inc. Address Address Storm Sewer 14795 SW 72nd Avenue Linear Ft. — Sanitary Sewer N C Devel opment Linear Ft. Owner Mailing Address Fresh Water 14795 SW 72nd Avenue Linear Ft. City/State one Catch Basins Por OR 97224 620 -4020 # General Name Clean Outs Contractor Owner # Prior to permit Mailing Address - Describe work to be done: issuance, a NewO Addition❑ AlterationD Repair copy of all 14795 SW 72nd Avenue ❑ licenses are City /State Zip Phone Additional Description of Work: required if Portl and, OR 97224 620 -4020 • expired in COT State Const. Cont. Board Lic. # Exp. Date 7. / t`1 ( j1.1 U3/9 C(____ database 04174 2/11/01 Name Project N/A Valuation $ 30,000.00 Architect Mailing Address Plans Required: See Matrix on back page The following, must accompany this application: City /State Zip Phone Site plan with Vicinity Map Parking (including Showing ADA compliance ADA) & Lighting Plan Name Grading Plan and details Landscaping Plan Kramer Gehlen Associates Engineer Mailing Address Erosion Control Plan and Retaining Structures 400 Cn1 umh1 a St tui t? 2110 details including calculations City /State Zip Phone Site Utility Plan and details Soils Report Vancouver, WA 98660 289 -2661 (showing connection to (if required) 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 cu. yds. agen of the owner, and that plans submitted are in compliance wi Oregon State laws. Grading Volume S' • -ture of 4 s - • i Date (Soils report required for >5,000 cu. Yds,) / Orifi g -/f- pi) cu. yds. Fill Volume Cont t Person Name Phone (Fill exceeding 12" in depth shall be compacted To 90% of Maximum Density) _ Cartal es 620 -4020 cu. yds. Retaining structure? (check one) • DRock FOR OFFICE ONLY ❑ CMU Notes: Concrete • 11110ther Total new impervious area including all Land Use Case # ,) lot) Map/TO buildings, sidewalks, and paving Sq. Ft. , 1. (0 C '6. if "Du PP CITY OF TIGARD / COMMERCIAL SITE WORK PERMIT / 0 i:\dsts \forms\site- app.doc 3/17/00 r ,. l - I, 1,5 CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 4, §iness Line: 639 -4171 MST BUP (O Date Requested " g AMPM BLD / `� Location 7 9 C A/ 12-' / '1"-/ �i rI ' suite MEC Contact Person Ph .245 7 / / r PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT 2' a ' O / y Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm CO �� Susp'd Ceiling q(/ O Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab - Top Out Water Service Sanitary Sewer „ Rain Drains �//e/ av _ r / Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PART FAIL SITE I /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date 5/0/a Inspector Ext in w PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST i 24 -Hour Inspection Line: 639-4175 / Business Line: 639 -4171 BUP 7 7 Date Requested / / / U AM PM BLD Location / °77,0 - L.1_4 4 114/ Suite MEC Contact Person D 6-0 Ph o? 53 7 & PLM Contractor 5°4 / 1 Ph SWR BUILDING Tenant/Owner ELC Reta'i'n. Wall • ELR ootin• Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: �� Gl D Slab S oq ODD Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation - Drywall Nailing Firewall Fire Sprinkler Cys- Fire Alarm Susp'd Ceiling Roof Misc: Fi . PASS) PART FAIL BING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date / 71/110 U Inspector 72 Ext Other - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 ! Business Line: 639 -4171 BUP 41A /P7' Date Requested `1 °O AM PM BLD Ir/ I Location l4 .; 14l/ 72�. / /�u-� Suite MEC Contact Person Ph g<-7//7 PLM Contractor 5'v Ph SWR UI Tenant/Owner ELC Retaining Wall ELR Footin. Access: Ria—Ui-eade FPS n SGN Crawl Drain Inspection Notes: Slab SIT RQge ---ov6,75 Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Drywall 0 /C 3 ,� L Drywall Nailing G C./ � L/ � P //' Firewall /f Fire Sprinkler QA-! f U `� C/ ,/L/ / G ' - ? ,P,4 c c Q Fire Alarm /a Susp'd Ceiling Roof Misc: ZD PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading • Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA - Approach /Sidewalk Other Date / i i Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.