Permit CITY OF TIGARD SITE WORK
A itk DEVELOPMENT SERVICES PERMIT
PERMIT #.......: S I TSB -0046
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 11/16/98
PARCEL: 2S1O2AD -02200
SITE ADDRESS— : 08900 SW BURNHAM ST
SUBDIVISION.. °.: BURNHAM TRACTS ZONING: CBD
BLOCK.. .°°. °.. °: LOT •006 JURISDICTION: TIG
CLASS OF WORK.... :NEW . PAVING? ° N RESO. NO. :
TYPE OF USE °COM : GRADING? • N VALUE... $: 8000
EXCV VOLUME: 0 cy LANDSCAPING ?....: N
FILL VOLUME: 0 cy SITE PREP? • Y
ENG FILL? N STORM DRAINS ?...: N
SOILS RPT READ ?: Y IMPERV SURFACE: 220 sf
Remarks: Site work for monopole
Owner FEES
BURNHAM BUSINESS & STORAGE type amount by date recpt
9490 SW BARBUR BLVD PLCK $ 44.53 B 10/12/98 98- 309907
STE 200 FIRE $ 27.40 B 10/12/98 98- 309907
PORTLAND OR 97219 PRMT $ 68.50 DEB 11/16/98 98- 310814
Phone #: SPCT $ 3.43 DEB 11/16/98 98- 310814
EROS $ 80.00 DEB 11/16/98 98- 310814
Contractor: ERPU $ 26.00 DEB 11/16/98 98- 310814
SCHOMMER & SONS INC ERPC $ 26.00 DEB 11/16/98 98- 310814
6421 NE COLWOOD WAY QUL% $ 17.50 DEB 11/16/98 98- 310814
PORTLAND OR 97218 WQUN $ 24.17 DEB 11/16/98 98- 310814
Phone #: 287 -4646 $ 317.53 TOTAL
Reg #..: 004937 •
REQUI RED 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
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started Final Inspection
within 180 days of issuance, or if work is suspended for more '
than 1:' days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952 -q-0010 through OAR 952 - 001- mi Your may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -9187.
Issue by: ��� l Permittee Signature : ��CU
•
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Call 639 -4175 by 7 :00 p.m. for an inspection needed the next business day
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CITY OF TIGARD Site Permit Application Date R �dl +— Z '1,
13125,SW HALL BLVD. Commercial: Complete ENTIRE form Date to P.E. 0 ti
TIGARD, OR 97223 Residence: Complete SHADED areas Date to DST /0 Mr , . 17-7'+
(5'03) 639 -4171 x304 Permit #G1 ''t i• 0
(- jl� J tX Related SWR #
�� ,0 ,� Called
\t Print or Type 10-2_(-1 — o
\ \'� Incomplete or illegible applications will not be accepted
Mt----- Name _ l Utilities (Complete all that apply)
Job \Vr XI t` t....- i \ l' 1 1 5
Address Address Storm Sewer .
'C"
C " ` Linear Ft.
ame Sanitary Sewer
1 : \ vs,\IN ,.0,,1 illt t� t; Z ccl _ Linear Ft.
Owner Mailing Address Fresh Water
1.1 4(1. N j z )N, , L a C0 Linear Ft.
C/4tat -- Zi Phone Catch Basins
i - U ' cIT q z_C�iS- c-r24- #
General Name ` Clean Outs
Contractor A. (, L,\ C,1;\ t< (` "- , #
Prior to permit Mailing Address Describe work to be done:
issuance, a
copy of all C f!� p Al' 1 ( ( Ti New Addition❑ Alteration❑ Repair❑
of t` Ti
licenses are City /State Zip — I Phone Aral Description of Work:
required if
expired in COT State Const. Cont. Board Lic. # Exp. Date
database
Voject _
r - � � . Valuation $ � , C r r
Architect Mal ing Address . ` � Plans Required: See Matrix on back
2, r 1 \ c V O.0 ‘� A The following, must accompany this application:
CthaState ( '� 4Pi h one Site plan with Vicinity Map Parking (including
\-- o 1� / Showing ADA compliance ADA) & Lighting Plan
Name 1 Grading Plan and details / Landscaping Plan
Engineer gailing Address _ Erosion Control Plan and Retaining Structures
4 Cr) j' 1, ('t t r `A_11 l _ det including calculations
City /State Zip Phone ' j" Z-+ Site Utility Plan and details Soils Report
ah_� (showing connection to (if required)
��) V (', 2qY .5 ? -( approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
(Soils report required for >5,000 cu. Yards information given is correct, that I am the owner or authorized
cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill Volume Signa f Owner /Agent Date
(Soils report required for >5,000 cu. Yds.) .
Cu. yds. (N,`--- ''∎_,.._ __) ) L
Will the fill support a structure Co tact Person Na n p
(Engineer required if answer is yes) YES❑ NOD
CL o
Retaining structure? (check one) ❑Rock \ FOR OFFICE USE ONLY
❑ CMU Notes:
N (
Concrete
N ❑Other
Total new impervious area including all Land s cj}ase # / 1 Map/TL#
buildings, sidewalks, and paving ? (Sq. Ft. 5b I b — ODI "
siteapp.doc 3/98 fLn it 1 /0
fvflw 14q5-
- 1113
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan : +eit# u on submittal of BOTH plans AND a CfAAE:'
I ont
n c r application i must
applicafion. Far � e e t Ical subm�ti�l; the � pp cat on
signature of the supervising electri0i#n before plan review will be
w coed cted.
After plan revie approval Plana aminerriil contact the applicant to reques
additional plan sets for distribution purposes (Copy for Contractor City,
Washington county, Tualatin Valley 'Fire
E OF SUBMITTAL . Plans KEY:
...........
_ _ Submitted
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
*B or B & M (Alt) 1
*B &M &P(Alt) 3
&M &P &E(Alt) 3
*B &M &P &E &F(Alt)
NOTES:
is �Xi'. i.'•i <:• { i ttitit iRt >i'::•' ?�: '
�y .•?)•} f`•`- ij.: R: i;; Ri: � ^::;}:; is�r .' ?�;niii::k ?k <:`_zy <:'.......
;Slladed areas deli H AL
I: \dsts \maxtrixl .doc 07/06/98
%
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 5igi3
A .LA c ci__ Date Requested /��� /Cd AM PM BLD
Location ' / ■0 0 SIC) MEC
Contact Person Ph PLM
Contractor Ph SWR
ING�° 3 Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: C ‘2_/‘4/1. ^(' Q SGN (� /�
Slab , Cn Q — l .L C-1 / U S IT fl — V o
Post & Beam o
Ext Sheath /Shear
Q
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
FiFT�
a , PART FAIL
i BING - °
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In — V
Gas Line Amps
Smoke Dampers
Final
PASS PART FAIL
ANNOY
ELECTRICAL _
Service i` 1 � (q
Rough In �// /
li[ V
UG /Slab rr\\ �,A
Low Voltag b ( U 9.
Fire Alarm Li
Final / a
PAS -ART FAI
ac fill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 3 /f Inspector — Ext3
PASS . PART FAIL 0 NOT REMOVE this inspection record from the job site.