Permit CITY OF TIGARD SITE WORK PERMIT
DEVELOPMENT SERVICES PERMIT # : SIT2004 -00016
.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 8/13/2004
SITE ADDRESS: 09000 SW DURHAM RD PARCEL : 2S114AA-00100
SUBDIVISION: ZONING : R -4.5
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 80,000.00
EXCV VOLUME: 900 cy LANDSCAPING ?:
FILL VOLUME: 1,300 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT READ ?: Y IMPERV SURFACE: 3,500 sf
Remarks: site work.
Owner: FEES
SCHOOL DISTRICT 23J Description Date Amount
6960 SW SANDBURG RD
TIGARD, OR 97223 [BUPPLN] Pin Ck -Valu 5/14/2004 $412.69
[FLS] FLS Pin Rv 5/14/2004 $253.96
Phone: 503-431-4003 [WQUANT] Wtr Quant ° 8/13/2004 $550.00
[ERPRMT] Erosion Cntl 8/13/2004 $80.00
Contractor: [ERPLN] Ersn Pick-CWS 8/13/2004 $26.00
ROBINSON CONSTRUCTION [EROSN] Ersn Pick-001 8/13/2004 $26.00
21360 NW AMBERWOOD DR [BUILD] Prmt Fee -Valu 8/13/2004 $634.90
HILLSBORO, OR 97124 -9321 [TAX] Valu 8% State Stu 8/13/2004 $50.79
Total $2,034.34
Phone: 503 - 645 -8531
Reg #: LIC 63147
Required Inspections
Ersn Cntrl 681 -4444
Sprinkler supply lines
Misc. Inspection
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 -0100 You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By : _
8/13 Permittee Signature: _ c ,_ CSC " by 0
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Work e(P2..vy- voa,4, COP do. WOO
1Su1liding Permit Application . FOR OFFICE USE ONLY " ' " .
/ Permit No.:
City of Ti and Received
y g Q� ® N Date/By: �G 5��— Od C7
13125 SW Hall Blvd., Tigard, 722 Plan Revie ` r ��
Phone: 503.639.4171 Fax. 503.598.1960 �aa N �pNj�l Re
'�� Date/B B / Other Permit: I/ pU�IJJ
inspection Line. 503.639.4175 `, � ' 'flail Date ady /By, iur s EL See Page 2 for
Internet. www.ci.tigard.or.us MAY 1 4 2004 r Nootifed/Method• (� 0 ,, Supplemental Information
rs it / C r' T r'Arirl " , !�I � �' / , -, !' l /
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Permit fees* are based on the value of the work performed
III New construction [1] Demolition Indicate the value (rounded to the nearest dollar) of all (�
71 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the T�
•` , ,e s' y- q -�'� t;;�';.^a c,, >,: ^.s �s�; <: m�,�,, ,4>.a.� �s,s '�,s� . ; 4 �, '
-;, ,,,, j!; ', work indicated on this application.
, ; 4 " ,t ` ; "i .V. k ,CATEGOR r� ORx' CQIVSTRUC = ;a` ; . ,�. ;x`
, :
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Valuation: $ g7D ( 6
❑ 1- and 2- family dwelling M. Commercial /industrial
❑ Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
f.'" V' "', : 4 ,; ;;;r ,'.. /,; y, ,: ;= „'� I';.1 : i . 4'.. • v t - Total number of floors:
h -, ka JOB ; ; 3 SITE .4 ,,,, ;' '�,; ; ".
:` "a„ `�,�- a�?�roa: .n �:,,€a�.a °�a�n.�, ,,a ^�a•,r <�,abua� ^.,�� <; ^waaa��•rr,.. <, . m ..� ` - , ,.., ,.. x., ", ,
Job site address: I SL) ougUym (j. New dwelling area: square feet
City/State /ZIP: T(>Avo aVc c-7 Z Z3 Garage /carport area. square feet
Suite/bldg. /apt. no.: Project name: MI6-A.K.C) (-\.5 p.($E Z Covered porch area: square feet
Cross street/directions to job site: I u. 13Lv ? TD POleikMA . Deck area: square feet
Other structure area: square feet
,, 7-1,..... ' `T REQUIRE D DATA "COMMERCIA
L =:E K LIS T _
Subdivision: Lot no.: Permit fees* are based on the value of the work performed. ' 0 4
— 2 5 ' OD ,�/ 0 0 Indicate the value (rounded to the nearest dollar) of all is
Tax map/parcel no.: equipment, materials, labor, overhead, and the profit for the
_ <,= ,14, a : ='3. " "`�` , ;WE TI,-:.. ' b.: n'-„5f *r;:'t' „ ;.,f,,, ,Z7, ,1 Y work indicated on this application.
° -?i :4 ` =e: ',k: .; Jt_ ' , - a.9 1 i ::; , DES @RIP OF , WORK } u ,,0 :)1 k;,. i d i PP
Valuation: $
LEND Or lCSD 5 la0W:CON 0 W...006-. (11 Wt11'4
Existing building area: (ZZ. 665 square feet
Nth) Z -S-11)1 "( G SS OA r'SLhC . M)) MrsL S4
(M vEwiJo.fy (ii D A lb B AST BOA �/ , New building area: ii Z square feet
<5, w,v=,.�.n. _. ,',- , -- = ' + +,;x..�Yki�,'�o.° � �, ,. ; � '.Y�s. - _ �;;a, .,.<
:,' ; <'?i' < .' < °t " ' Number of stories:
- ; :1?ROP 0 ,OWNER •''' , _ ..TEIVANTy.° ' `' -:,. � 4 t` 2
Name: T ► . j - - Eys4. tk-'I t cai -OOL l'JL5112% r Type of construction: = 1— iADOyL,
Address: 69 (oD ) S ,6, 1. 4 2(x.'. Sr. Occupancy groups` E._,
City/State /ZIP: 1R,A1,20 C* 5h 2Z3 Existing: g,_ I
Phone: (SO'S) 93 .. zipt3 Fax: (Q e?J(— J Dy1 New: Z —(
� Yxz` - -:- �; ��.s. :.�:�'� - � ., - s�v - ;fi s- ,.�ezrn,. :�::�a::_r ..� % ,,.,
x : : :_ ; :' CONTACT,:PERS, , -;'; ..
®�APPLICAIVT "� � , � � ;�;:.,' ;�
, ' r'� - :. `; 4 1VOTICE ; . ` r
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Business name: p(x,(., OI. 0 to Ems ,64,24441CQS All contractors and subcontractors are'required to be
l'�f .� �(�� ) licensed with the Oregon Construction Contractors Board
Contact name:
�vr � ti under ORS 701 and may be required to be licensed in the
Address: 319 Sin) k '!ii6 f g) 9 --. *t Zoo jurisdiction in which work is being performed. If the
City/State /ZIP: Ppeft.."�7 ' DK.. ¶'7 Z7) 4 applicant is exempt from licensing, the following reasons
apply:
Phone: ( ZZ .. 6,55-O Fax: : (S(;1'5 ) ZZ3 — 5 1 i C 'f Z Ll' /0-.01
E -mail: e. J C �.1)l al a . cM 5 $
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iz Y' .: = J 4 :; - ��'��''»:s'E' ....F'.��,st -?:. �;«a:?v�r. =.. ; w_ ..<;� �r'� ^; .7� _. ,1 ,�� -t. 2t.3`:�'�rk.";� ? b � ��
' Business name: A It( LY J ..)' ..: JLTttt.) „� ::4 " . , ., ..,k .. ;. : ,.:
� t `', ; r e a, t; , BUII. 4 . - EE RMIT - 'FEES . ' _,•t, "": ` ,': = •
Address: 2(36 a) NW Al..i►3 WDDb t1Vf,
Please refer to fee schedule.
City/State /ZIP: Blue, y ]D 02 • 9'12
p Fees due upon application
Phone: (563) (: — a J' 3 ( Fax: ( ) (j s -' g3 51
Amount received
CCB lic.• 63 [91
' ` Date received:
Authorized signature: ( I� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Cja ir\r\tCli`seK•JS Date: S/( 4(6 Li * Fee methodology set by Tri -County Building Industry
Service Board
k \Building \ Permits\SIT -PermktApp doc 12/03 440- 4613T(1 1/02 /COM /WER)
. ,
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: cl DO cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 25'0 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) l3 b o cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
Concrete CAT L J4Mg%G 1
❑ Other: SrAtrz 5 Of- wies.u.5)
*Total new impervious area including all
buildings, sidewalks, and paving: 3,5 sq. ft.
- •a.0 ,�. TSw.;� .��.; ^a".,�e''c'�� " " €i,,; >ox �. ;se�� - - .=r� , s � '
•F� u.r - - . ' "' ',. .;.�'' - :..#��'�' 'y;�:� �'„.,, u �
,`�' <' ':�a , M'1 i '''; - - : t =x •"$ ,,€ _ ,V J -€-,` 1 ar -s; ,< u �:'��'§, <s „34.,x•:. n'''"s �. ; :, >ksz;iS:.,.ao-
aa��v4 t. d+ sa���� .'����•�`�•���..€�.�:aiwaw ���:�t�.�- �„`'7`,+,'.y., .,� �,.x �'52�"�` >.r�.,'; _�..W,'c �. �,�.�aZ'x ...tea-, -., m�9 -., ss:t v__.�s:�, -.��
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work. ,
Plans Required: See "Site Work Permit Application - Plan Submittal Requirements"
attached. The following must accompany this application:
❑ Site Plan with Vicinity Map showing ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
❑ Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two - family dwellings.
€� r. =. „.� " c�i�;:`.,� "` g3""��:_,` m ';t ",:��;'p�: "�4_,,,4�s „ #a�
: , i
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; •FT.,, x'..`'9 .,,..: Re .u
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, „ , i F; . ..
} ;u :�r. e � ;," ,oft ".� >:. .�.. ,� � € � � °.�� ,« t �;,'
i Alnclud'e New Add bons 6VAllteraii iii) ; ' "`;:Submittal .. `
Commercial 2
Multi - Family R -1 Occupancy • 2
•
One- & Two - Family Dwelling 2
i.\Building\Forms \SIT - Checklist.doc 12/29/03
C .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: SIT2004 00016
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/13/2004
Phone: (503) 639 -4171 //44,
Inspection � 1 � z�i
Inspection Requests (24 Hrs.): (503) 639 -4175 `__L
INSPECTION WORKSHEET FOR DATE: 9/1/2005 TIME: 7.14AMVI PAGE: 75
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: site work. 1/25105 Revised to Phase HA and IIB
OWNER: SCHOOL DISTRICT 23J, PHONE #: 503 -43 -4003
CONTRACTOR: ROBINSON CONSTRUCTION PHONE #: 503 - 645.8531
Inspection Request Scheduled For: Date: 9/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
499 Final inspection 014757 -01 50209 -1625 N
Corrections /Comments/ Instructions:
----- 40 I „op
. . _.,,, , 4_
\ _ r
•
A SS I l PARTIAL APPROVAL — CANCEL El NO ACCESS
I I FAIL FOR NSPECTION n ADDITIONAL FEES ASSESSED
- 0, 41/4 L
Inspector: Date: I Phone #: (503) 718-