Permit .,c
CITY OF T I G A RD SITE WORK PERMIT
4 DEVELOPMENT SERVICES PERMIT #: SIT2004 -00018
.�.� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 2/1/2005
SITE ADDRESS: 12630 SW GRANT AVE PARCEL : 2S102BD 00800
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING : R -12
BLOCK: LOT: 009 JURISDICTION : TIG
CLASS OF WORK: ACS PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 3,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT READ ?: IMPERV SURFACE: sf
Remarks: Site work for 1000 sq ft storage building, reduced impervious area.
Owner:
FEES
ROMAN CATHOLIC ARCHBISHOP OF Description Date Amount
PORTLAND IN OREGON
2838 E BURNSIDE [BUPPLN] Pln Ck - Valu 6/16/2004 $46.87
PORTLAND, OR 97214 [FLS] FLS PlnRv 6/16/2004 $28.84
Phone: [BUILD] Prmt Fee - Valu 2/1/2005 $72.10
[TAX] Valu 8% State Sui 2/1/2005 $5.77
Contractor: [ERPRMT] Erosion Cntl 2/1/2005 $80.00
THE ECAVATORS LLC [ERPLN] Ersn P1ck -CWS 2/1/2005 $26.00
PO BOX 690 [EROSN] Ersn Plck - COT 2/1/2005 $26.00
YAMHILL, OR 97148 Total $285.58
Phone: 503 - 649 -5354
Reg #: LIC 152333
Required Inspections
Paving Insp
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:
Permittee Signature: S -. \(:)
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Work
Building Permit Application, O � FO R OF U SE ON
Cit of Tigard � � O Received
Date /B permit No
�� i / i
�
13125 SW Hall Blvd., Tigard, OR 97223 \`1 Pe . �, Plan Review
nu
�� ygy 1p r C � OS ` �! Other Pert.
/9
Phone: 503.639.4171 Fax: 503.598.1960 � � N i 0 Date/B ° p" fr%'
Inspection Line: 503.639.4175 � ' .. LIJP , ' I J . Date Ready /By. /7 IM ® See Page 2 for
....cc N� Notified/Method: (Lc Supplemental Information
Internet: www.ci w` �10�
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�✓ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
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�� Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial /industrial
---- Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: , •
” ;'t ^ta€ ; ; " ,'r. , ,:> ,k 2, : ;:-:� IO <� ,,. _ ,;,., :,. ;.^ Fn, , ..,, : ''',16R Total number of floors:
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Job site address: ( \\ -.c=a kir A`r'm New dwelling area: square feet
City/State /ZIP: ` e p 1 p , C g f)'7 22-3 Garage /carport area square feet
Suite/bldg. /apt. no.: Project name Cl Nei(a3.76e_4044 w6 Covered porch area: square feet •
Cross street/directions to job site: 5 \\/ p - Sr C$ I N,TSR,5ISCIIO N Deck area: square feet
L Other structure area: square feet
FIRQUIREDiDATAOMMERCIA'=USE C HECKLIST
Subdivision: Lot no.: c SOC) Permit fees* are based on the value of the work performed. '
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: 2 S ( � Q 21, t7 equipment, materials, labor, overhead, and the pr f for the
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.x 4°" . - ' ' O WORK ; J 6 66
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I S F S-rmzo , Valuation: $ —
Cor� - cam
Existing building area: 0 square feet
• New building area: ( (0 O 0 square feet
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Name: ' r-cocr0+.btCeo'T's4D t -I ./ tebt.ts) WA CteSruripPq Type of construction: V ts
Address: 21e,3 G, gt l'yZt4,s,-tom Occupancy groups: S —1
City/State /ZIP: F,ir¢�.by4 0 l <S s .7 2-1 4- Existing: No tits
Phone: (6 CO3S-1 -12 Fax: (5 (az+ "2 4-- New: Ss
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Business name: ' T A r T hi 0 tqz 10 siaJ ski All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: �'
m8 q' `I�C,„S c - r t4 Sm 3 - 6S�? I under ORS 701 and may be required to be licensed In the
Address: 13�� S
3
5 \Y coriS }. jurisdiction in which work is being performed. If the
1-- 223 applicant is exempt from licensing, the following reasons
- -
City/State /ZIP: l t CQ 8+��, c2� s apply:
Phone: ((Q' ) 63°) —yH ?° Fax: : (603) X24 — 2.31o4—
E -mail:
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Business name -rygfl _ \ , „; ; ^ , % ;s:;a„ � ,•` „, _ .,_ ...:- -`�',._ *Nrt; <':
`-� Cp1� �J r � - ,: BIJII: •P ERIVIIT FEES ' ,
Address: -' n ,3 ,,><. 6 l O n Please refer to fee schedule
City/State/ZIP: \\1,...\.:, ` \ \ ( 7) V Fees due upon application
� I
Phone: (Y) to q4 --SJJ / Fax: ( )
Amount received
CCB lic.: / 5 ; ,j e - 7/ AVp
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: 'R s ,..er 1,1 Date: Co/ - 7( a ¢ * Fee methodology set by Tn -County Building Industry
Service Board.
i 18mldmg\Permia \SIT- PemmApp doc 12/03 440- 4613T(11 /02 /COM/WEB)
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:
544 - (Soils report required for >5,000 cu. yds.) cu. yds.
c4.41 4.. u — Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) cu. yds.
N/A Retaining structure? (Check one) ❑ Rock •
❑CMU
❑ Concrete •
ADnGP ❑ Other: •
c�.v4 vsSa��Kc *Total new impervious area including all
Rs-pLy -P0 buildings, sidewalks, and paving: sq. ft.
n-- �:y� ",;.�� .,.,max, ,��� ':�. f� ..:; -' .�.a ���;� .�.r:', ,..,,,z
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1 N1 P'6 w�G:� ''Yam: � ' �„'3, .,r} °' �e°2i: '
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A Q-r.,A
,:Awes. 11-04..) 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.
> }� �':•`'' =3� -� � :�s A ,� : �, - ofeP -laps ".• _. .
o - i ,, �I ;,, :i�. -•�:r:�9a, -ei; ".;! µ ` p$.:`; r ' �'., 'r� ,�, %�yCy , .: ".,„
gg ' ' 'TYP :n E °£®1Fr °BNIITTAL °.:, n Required;at
5 f ,,.Ry,,';:;. ' r 5 ..
a r ld u :2i � ;S; � des New Add 'ti ° oris QT :=AlteliA9ns Sub °in tfal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
i"\Building\Forms \SIT - Checklist doc 12/29/03
CITY OF TIGARD
BUILDING DIVISION At PERMIT #: � �T
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2. t -
Phone: (503) 639 -4171 N �
Inspection Requests (24 Hrs.): (503) 639-4175
'
INSPECTION WORKSHEET FOR DATE: !s /c— TIME: PAGE:
SITE ADDRESS: 12„.4,C j(.j GAT CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: T No- - ys
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
LK? F? its 1 WSP
Corrections/Comments/Instructions:
..------/ , Al
■
' ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED A )
Inspector: �, r'+k/ ` Date: SPhone #: (503) 718-