Permit C ITY OF T SITE WORK PERMIT
r=A DEVELOPMENT SERVICES PERMIT # : SIT2004 -00032
4.4 � PARCEL : 2
II 13125 SW Hall Blvd., Tigard, O R 97223 503 - 639 -4171 DATE ISSUED : 2 S112D
S112DD -00300
SITE ADDRESS: 15900 SW 72ND AVE ZONING : I -L
SUBDIVISION: LOT: JURISDICTION : TIG
Project Description: Site work.
CLASS OF WORK: OTR PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y VALUE: 29,450.00
EXCV VOLUME: 0 cy LANDSCAPING ?: Y
FILL VOLUME: 0 cy SITE PREP ?: Y
ENG FILL ?: N STORM DRAINS ?: Y
SOILS RPT REQD ?: N IMPERV SURFACE: sf
Owner:
FEES
TIME OIL CO Description Date Amount
P 0 BOX 24447 [BUPPLN] Pln Ck - Valu 12/30/2004 $208.52
SEATTLE, WA 98124 [FLS] FLS Pln Rv 12/30/2004 $128.32
[BUILD] Prmt Fee - Valu 6/6/2005 $320.80
Phone: 206 - 285 -2400 EXT. [TAX] Valu 8% State Surcharg 6/6/2005 $25.66
Total $683.30
Contractor:
MENG - HANNAN
5906 SE 122ND AVE
PORTLAND, OR 97236 -4607
Phone: 503 - 761 -5290
REQUIRED ITEMS AND REPORTS
Reg #: LIC 47283
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 • - - _ -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1-81'e-332-2344. n
Issue By: L 11l .4 4 _ 4 Permittee Signature: ,C �
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/Spoo 5 C 2
Site Work ski/ fkIir
• - Building Per , sa ,Aill) ice, E.0 FOR OFFICE USE ONLY
Cl of Tigard Received / Permit No
`J 4 DateB : '3 t I r ,o — t�V0
13125 SW Hall Blvd., Tigard, OR 7323 , -- Plan Review / /a. ?' o Y
p -
Phone: 503.639.4171 Fax: 503. 8. 96 Date/By: /!iQ Other Permit:
Inspection Line: 503.639.4175 -N OF Y IG AA0 : j I1'I s F_ i f Date Ready/By: 3 r El See Page 2 for
�� N Notified/Method: ( Supplemental Information
Internet: www.ci.tigard.or.us 1NG D�VIS10
BUILD o
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING 01
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
K Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling tx Commercial /industrial
❑ Accessory building El Multi-family Number of bedrooms: `\
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1561 G 0 sw TAND . Ali • New dwelling area: square feet
City/ State/ZIP: -r itiftio . 0 2 c1 7 2_2 Garage/carport area: square feet
Suite/bldg. /apt. no.: ( Project name: S ti E LL. STP'rt o PI Covered porch area: square feet
Cross street/directions to job site: 5 E c K. N ER .7 ..),,A 14,)1) Deck area: square feet
rl
5w iA, PeTc D CONES FI 1U?'j 'RD. Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 0 0 3 00 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: S )� 'Z D Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ II, It $Q — REISkti .* a i N (r &AS S nvn 0 k ISLA -NIDS
AN 6 GIN 0 P% Existing building area: 12_6%, ( square feer,
New building area: 2.A 3. square fee
X PROPERTY OWNER ❑ TENANT Number of stories: I
Name: TIME 0 i L CO Type of construction: 11 R U1.
Address: PLO . 134X 2 WO Occupancy groups: •
City/State/ZIP: c 7 - t - L t vol- cig 12,4 - of 41 Existing: M
Phone: 2g5 2zi®0 x326 Fax: (ZP.);LS(v-Livi(v New: M
R APPLICANT ❑ CONTACT PERSON NOTICE
Business name: A RC.i 1 rEt rIAR - h rt W ES 1 P, C,. All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
PE I Prz under ORS 701 and may be required to be licensed in the
Address: it 6 1 30 So 7-.104 HILL j R , jurisdiction in which work is being performed. If the
City/State/ZIP: � 4 j 1P4 0 E. 4 102'0
applicant is exempt from licensing, the following reasons
apply:
Phone: (503) scg- g4 Zq Fax:: ( 5)3) �r'5 4 z 1 2_
E-mail: tL PPrrz DGSitiN e_ 11ttt®o t C014
4
CONTRACTOR \\
Business name: 'i'?i Q - tit‘ C e: BUILDING PERMIT FEES*
Address: 5 t1 4i. 1 ? 4-0 fi Please refer to fee schedule
City/State/ZIP: ty L 0 a- Fees due upon application
Phone: (5j,) 761 -;"?-9 0 Fax: ( )
Amount received
CCB lic.:
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: Q E � l�r r P E p_4.- Date: 12, 22 (� 9 * Fee methodology set by Tri -County Building Industry
` Service Board.
i:\ Building \Permits\SIT- PcrmitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
I
City of Tigard: Site Work Permit Checklist -
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"
att ed. The following must accompany this application:
Ile Site Plan with Vicinity Map showing 2' *Parking (including ADA) and
ADA compliance Lighting Plan
❑ grading Plan and details , *Landscaping Plan
1/ Erosion Control Plan and details I=1 Soils Report (if required)
o ❑ 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
•
Multi - Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
i:\Building\Forms\SIT- Checklist.doc 12/29/03
1
07/22/1996 02:31 5036584272 ARCHITECTURE_NW PAGE 02
02/01/2005 07:47 5036243681 TIGARD BUILDING DEPT PAGE 02/02
RECEIVED
Cit of Tigard: Site Work Permit Checklist FEB 2005
Page 2 - Supplemental Iufb�ation
CITY OF TIGARD
e - s and shin s : B UILDING DIVISION
Flo permit is required if fill i® leas than 50 y ( dump t ruck loa or l ess tha 3 feet deep
and will not be supporting a structure. Ha 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: Q cu. s.
Crrading Volume!
Soils re • ort i - • aired for X5,000 cu. ds. 0 cu. ds.
Fill Volume:
(Fill exceeding 12" in depth shall be
co » • acted to 90% of maximum dens' 2Szt cu, ds.
Retaining structure? (Check one) ■ Rock
NO CMv
a Concrete
❑ Other.
*Total new impervious area including all
apt buildin �A sidewalks end .. ' 1 0 s ft.
L1.,i. I I I r,. I
_.:.. l.. , u Ifu.lf I '< �. Jri.' txlr. tJ4lcl.: ... 5",? �Illll��� _I,GVaI:�h�jh�jf"v�f.L "•� `r i III!/'.{ °; � 3, �2f�:s5N . .i��tt
Site Utilities Plumbing Work:
• .
date the Plumbing Permit y . lication for site utilities , lumb' 1 work.
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attached. The following must accompany this ap lication:
Li Site Plan with Vicinity Map showing 0 *Parking (including ADA) and
ADA • I • • fiance Li _ . t : Plan
11[ Grad& Plan and details • *Lands : , in : Plan
• Erosion Control Plan and details # Soils Report if wired
CJ Retai .his Structures i 1
*Does not apply to One - and Twafbmlly dwellings.
E i ti f + it . S' f• j ! } 7q « .;,. ; ';irr f r ',%,_;t a.l . ;y,;.Cit`
1j lllfi 1 I'. n1 i �rr r''.::
I1 � r f�lll.�ilnllCl`il 1 .l1� jIJJ�t�I ��i S�r. r 1i. m
", 1'
:ll �y
f' rt" I �r U III f 7� r1 I 1 : Z q 1 �N a • � q .r•.
,.�.Gti� t .� L11 I1 I� 111 "11 r}11t7n�Q'r .1A T n'nn r:�: ' d I .:
ti l].fy�
i;!U.) .tic.ul� �J.. t.a— .:�.�Jw.w..m �..:�.,�...•v....h.C.,u.� f� � I :.•t , v✓ ���
Commercial 2
Multi- Family R -1 Occupancy 2
One & Two-Family Dwelling 2
iAav>.dnnearrti slT.Chaldiptdoc 12!24/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: StT2004.U0032
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/60005
Phone: (503) 639 -4171 ' i l ' I
Inspection Requests (24 Hrs.): (503) 639 -4175 "- —
INSPECTION WORKSHEET FOR DATE: 1/31/2006 TIME: 7:01AM PAGE: 67
SITE ADDRESS: 16900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: jACI(Pt) T FOOD MART
DESCRIPTION: Sit.° work.
OWNER: TIME OIL CO, PHONE #: 206-206 -2400 EXT.
CONTRACTOR: MENG - HANNAN PHONE #: 513. 761- 32i30
Inspection Request Scheduled For: . Date: 1/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 02599t-01 111 -111 -1111 N
Corrections /Comments /Instructions:
•
•
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL • CAL FOR SPECTION ❑ ADDIT NAL EES ASSESSED
•
Inspector: Date: -t V Phone #: (503) 718- �� `�
CITY.OF TIGARD •
BUILDING. DIVISION PERMIT #: SIT2004 -00032
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005
Phone: (503) 639 -4171 : �1� Ijl`�
Inspection Requests (24 Hrs.): (503) 639 -4175 `-L
INSPECTION WORKSHEET FOR DATE: 8/11/2005 TIME: 7 :09AM PAGE: 85
SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JACKPOT FOOD MART
DESCRIPTION: Site work.
OWNER: TIME OIL CO, PHONE #: 206-285-2400 EXT.
CONTRACTOR: MENG - HANNAN PHONE #: 503- 761 -5290
Inspection Request Scheduled For: Date: 8/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 013281 -01 503519 -8788 N
Corrections /Comments /Instructions: Lo b t, D ( oa
A OD 2(:)"
ne r c6 cce k1— t 0.1 i (cur,- Oi r T(
o 6k T ___ 2 • SLoRE 00
r\-107 T P( iC_e--
0j3 07 6S OAS
❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
• �j ((J Inspector: Date: ( c5phone #: (503) 718-