Permit •
CITY OF TIGARD SITE WORK PERMIT
' i ' DEVELOPMENT SERVICES PERMIT #: SIT1999 -00028
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED : 7/29/99
SITE ADDRESS: 14865 SW 74TH AVE PARCEL : 2S112AC -01200
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING : I -P
BLOCK: LOT: 020 JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: Y RESO. NO:
TYPE OF USE: COM GRADING ?: Y' VALUE: $42,000.00
EXCV VOLUME: 4,000 cy LANDSCAPING ?: Y
FILL VOLUME: 1,500 cy SITE PREP ?: Y
ENG FILL ?: Y STORM DRAINS ?: Y
SOILS RPT REQD ?: Y - IMPERV SURFACE: 63,000 sf
Remarks: Site work permit - Soil Bearing Design up tp 3250 psi
Owner:
FEES
KHNS DEVELOPMENT
26262 S MERIDIAN ROAD Type By Date Amount Receipt
AURORA, OR 97002 MISC GEO 6/9/99 $98.80 99- 315772
PLCK GEO 6/9/99 $160.55 99- 315772
SQWM BON 7/29/99 $6,920.45 99- 317270
Phone: PRMT BON 7/29/99 $247.00 99- 317270
Contractor: 5PCT BON 7/29/99 $12.35 99- 317270
OINC EROS BON 7/29/99 $115.68 99- 317270
NELCO
MERIDIAN RD ERPU BON 7/29/99 $37.60 99- 317270
AURORA, OR 97002 ERPC BON 7/29/99 $37.60 99- 317270
Total $7,630.03
Phone:
Reg #: LIC 118731
Required Inspections
Erosion Control Insp•844 -8444
Excavation
Fill
Grading
Paving Insp
Strm Drain Insp
Culvert/Catch Basin ORIGINAL
San Sewer Insp
Manhole/Cleanout - PVT
Domestic water line inspect.
Final Report 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: o r
Issued By: "AAA
Call (503) 639 -4175 by 7 :00 P.M. for an inspection needed the next business day
•
•
•
pi; Recd By
OF TIGARD Site Permit Application Date Recd i 8
13125 SW HALL BLVD. Commercial and Multi - Family: Complete ENTIRE form Date to P.E. 9 - �r
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST 7 — 7 t�
(503) 639 -4171 x304
� C Permit # 5/ P J9'/�1- o6 allled ed 7 oz S'
V al - #
C 7-M --1
Print or Type
Incomplete or illegible applications will not be accepted
.• Proj Name Utilities (Complete all that apply)
Job F/9';006 :A 5 F�USi:VS55, t�'fIkl.�c'
Addre - Address Storm Sewer
/q' 5 kl 7 A t9 c / Linear Ft.
Name
Sanitary Sewer
K ft N5 p CuG�o/?p- tF�fl? D
`7 Linear Ft.
O M Address
Fresh Water
, �-= G , /` l • O E 1 I /»,fj /?p o () Linear Ft.
, �, Ci /State , Zip Phone = Catch Basins
General Name:: Clean Outs
Contr
/V GL rN� # 1
Pri t o perm - Mailin Addre r Describe work to be done:
i � � s
copy �b� - .+ /"tG�1 � /?! New . Addition❑ Alteration❑ Repair❑
licenses are City / Zip Phone ' Addi De tion of Work t ,
required if p i
C i tJ/Z 012 (U2 g7 O o •Z ''&; 'Y �l 7 , f j / e
expired in coT State�_Const Cont B L l c : # Exp ate C
database A r I '7 3) - r' ... .,.. l .9. d ! — �� 3 ..
Name Project
3: H. 5 //NtuND
V aluation $ : �. jlJ��• -� • A ehifiec Mailingg Address - Pl ans !R equired See Matrix on ba ck r
5/r-6- $ � 3 5' Sw GANyo c-/✓. [/v Z Tr Sid mu a c company tts_application • "Ni
City /State Zip Phone Site plan "with Vici Ma , ; ; Parking (includi
PAR- TGi�/uD o ,1 79" -�_s Z, 4 $fin Showing ADA compliance " :ADA) . -Lighting Plan
Name 6/ 02'Air" • Grading Plan an Land P lan
64126 QM 6.p G NG/NG6 - 25 /1 t.-
• Engineer Mailing Address Erosion Control Plan an Reta Structures
/o 4$' -- / 3 577 5 c details ; calculations
City /State Zip Phone Site Utility a nd d eta ils Soils Re port
�yg� - gill 01 2 973°2 � f�j�4 (s howing connection to ( r
3 - , a pproved system)
Excavation Volume • 1 hereby a cknowledge th I ha rea t th e i s application that th
(Soils report required for >5,000 cu. Yards) information g iven i s corr that I am h own or; authorize d
000 cu. yds. agent'of the ow and that plans submi tted are in - complian
with, Oregon State laws`
Fill Volume eG Si of O w n er / Date
(Soils report required for >5,000 cu. Yds.) R >
Q l
! o ° cu. yes. tac � , _ 5� Q 9
Will the fill support a structure C Perso Nam P..,hone
(Engineer required if answer is yes) YE NO� ls%�L Nom GS esr t � ' ` z
Retaining structure? (check one) ❑Rock FOR OF ICE USE ONLY
❑ CMU Notes:
NOa1.c ❑Concrete
❑Other Q
a s /1 -Of &B
Total new impervious area including all Land Use Map/TL# •
Case #
buildings, sidewalks, and paving 43,
00 Ft
Ft. 577 � 5
(Se FL i. �6
i:\dsts\forms\site 10/30/98 ■`' � �
hl w p � 4 F r>° G i �4j t>' A 49 ti SCI „....______----.4.---7-5.--
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
• ;_ ppli a on For an electrical submittal, the application must contain the
gnature of the supervising electrician before plan review will be conducted
ter::: �a`.:; <;.:.. . :..:.:::. >:: >: :..,.: "'<:; ::::.:<.; <::<;.;::;:::, :;::; ::<:<> :.: < ; > ; »<: ;::<::<: � << : : : : >st : : ::::>
Afte p n review approval, Plans Examiner will cont the applicant to reque
.:..........
addit a al< . ':lar set for disc i :.:. < .. , ... > :.;:,. e
TYPE O "
KEY:
d....
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
.B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
• B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
NOTES:
ded..ara«;.
.::::.:::::::::::::.:...::: s: ::::::::::.:: ::.:::::::::...LT: sub: rrtrftals: o�tl::..::::..:::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::: :::::::::::.:::::::::.�:::::
I: \dsts \forms \matrxcom.doc 12/17/98
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
F2---rf Date Requested r AM PM /C BLD
y �
Location , `�� 5 5 `7 � Suite MEC
Contact Person / Li 8 Co 5" 7 A-u-e_ Ph PLM
Contractor / Ph SWR
BUILDING Tenant/Owner /CE,7t7Z l i 2 ELC
Retaining Wall ELR
Footing Access: //b
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: /
Slab SIT / 999r' 0
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing -- -- .c
Firewall /
Fire Sprinkler �- ��/' � 'i 1
Fire Alarm L ✓�
Susp'd Ceiling !�� _
Roof
Misc:
Final
PASS PART FAIL r r
PLUMBING.
Post & Beam
Under Slab
Top Out
ater Service
anita
al s
Final
�jp PART FAIL
�'' CHANICAL
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 Dat • / Inspector /�� / /.� Ext 3
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.