Loading...
Permit -A - CITY OF TIGARD SITE WORK PERMIT I DEVELOPMENT SERVICES PERMIT # : SIT2001 -00009 y1-1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 10/29/01 SITE ADDRESS: 09870 SW JOHNSON ST PARCEL : 2S102BB -01600 SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING : R -4.5 BLOCK: LOT: 019 JURISDICTION : TIG CLASS OF WORK: OTR PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: $80,000.00 EXCV VOLUME: 72 cy LANDSCAPING ?: Y FILL VOLUME: 900 cy SITE PREP ?: Y ENG FILL ?: STORM DRAINS ?: Y SOILS RPT REQD ?: N IMPERV SURFACE: 13,200 sf Remarks: Construction of a new parking lot. Owner: FEES ST ANTHONY PARISH • 9905 SW MCKENZIE ST Type By Date Amount Receipt TIGARD, OR 97223 PLCK CTR 2/9/01 $412.69 27200100000 FIRE CTR 2/9/01 $253.96 27200100000 PRMT CTR 10/29/01 $634.90 27200100000 Phone: 5PCT CTR 10/29/01 $50.79 27200100000 Contractor: Total $1,352.34 FLOWLINE EXCAVATION 12685 NW NEWELL PL FOREST GROVE, OR 97116 Phone: 503 - 992 -7473 Reg #: LIC 87649 Required Inspections Erosion Control Insp 846 -8444 Excavation Fill Grading Paving Insp Strm Drain Insp Culvert/Catch Basin Landscaping 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 - 1987. Permittee Signat 4 re: Issuec*By: 1 _ , . �, �! '� - Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day . � ' oL SL- f12(o t Building I ;received: �/ P ermitno.;S/r ` 1 .. City of Tip �� p�o�9 ect/appl. no.: Expire date: CiryofTigard Address: 13125 SW Hall nivu- 71 -vt� 7-� - - — Phone: (503) 639 - 4171 Date issued: By:25 Receipt no.: Fax: (503) 598 -1960 n Case file no.: Payment type: • Land use approval: Ott / 1 7 — (10007 (10007 1 &2 family: Simple Comple ��� Complex: TYPE OF PERMIT ❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition ❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: JOB SITE INFORMATION • Job address: ' $' • .t.%) _ p SI, Bldg. no.: Suite no.: Lot: Block: Subdivision: Tax map /tax lot/account no.: ialhi , Project name: . T ly11.a '',.0 Vi • .o.,41 Description and location of work on premises/special conditions: G© !..A1 - C I _ - s. Or A .0__._ lt " OWNER ` , FOR SPECIAL INFORMATION, USE CHECKLIST . Name: i . sr .� ` IL (Floodplain, septic capacity, solar, etc.) Mailing address: ' l o 1 & 2 family dwelling: OE .1leL�y Stater ZIP: ' ''j Valuation of work $ Phone: Amami Fax: E -mail: No. of bedrooms/baths Owner's representative: Total number of floors • Phone: Fax: E -mail: New dwelling area (sq. ft.) APPLICANT Garage/carport area (sq. ft.) Name: l t ! ti.... ., V Covered porch, area (sq. ft.) • Mailing address: 61 p I IMSIWATrAMIM Deck area (sq. ft.) 1��► State:c _ ZIP: ' 2243 Other structure area (sq. ft.) Phone: Fax: E -mail: Commercial/industrial /multi- family: ' CONTRACTOR Valuation of work $ i<C 1 000 )( Business name: - Existing bldg. area (sq. ft.) CD Address: A ow et - New bldg. area (sq. ft.) 1 ' 1 �1 00 ' C l ' ° Number of stories C� City: e • t -„,., • WM ZIP: • 11 C. P d� ���I E-mail: Type of construction CCB no.: ;, 6 y Occupancy group(s): Existing: / New: City /metro lic. no.: Notice: All contractors and subcontractors are required to be ' 'ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under MEV l ; • ��., ., provisions of ORS 701 and may be required to be licensed in the Address: 621 jurisdiction where work is being performed. If the applicant is City: "per`( 1. 1� State:€ 2._ ZIP: ' 210 1111 exempt from licensing, the following reason applies: Contact person: � —( . Plan no.: Phone: . _- el... Faxr223_ • • E -mail: . ENGINEER • . . IMMIEMP .111111.111111 Contact person:( /____• J, t in;; s due upon application $ . . i Address: wt,��ir- 1 - ti p ;: � dll Date received: r L 110 EIZMI ZIP:. • 2 Amount received $ Phone: 2.0 �S t Fax "2() i1 E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of law . d ordinances govemi g this 0 Visa ❑ MasterCard work will be complied i whethe .. net fi • . herein or not. r Credit card number: I / signature: �7 • Expires Authorized si � �_.. u �-� ' �� "Da te: 2 � d I N a me of cardholder as shown on credit card Print name: . 1 Cardholder signature $ Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. � 440-4613 (6N0/COM) CA C I . a s p ib 60 � / / -gam L LI (d-W1 60- q / 57 .• - - - SITE'WORK= PERMIT CHECK LIST -- Commercial and Multi - Family: Complete ENTIRE form. Residential: Complete SHADED areas only. • Excavation Volume: 7 z cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) qoo cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) Cu. 4'8° yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other ❑ . • Total new impervious area including all buildings, sidewalks, and paving: 13 ZOO ' sq. ft. Site Utilities Plumbing Work: Complete the "TAN" Plumbing Permit Application for site utilities plumbing work. F:;PlansRequ�ced� Sege`` Site�UUork�Pernit =ApplicattonPlan�S,ubmittaf, �.� � .�} Requirements"attachedtThe olLowing rpust accompany thistapplication = l 494 i fSite Plan with Viemity Map P > arkmg (including °A)`and . rshowing „!A ®A compli Light!n F?lan 7::11-16%'N Grad] g ,Plan and details ''u _ -andsca In Plank ' e Iat trol Plan a✓nd details iz mn R iabiS`truetur ,, ' , „,, � ,Sitej "Ot IIty Plan and details§ s Soils Report (iffrequired) 3 ¢ (showing conn to�approved � � 4 � 4 • is \dsts \forms\sitechecklist.doc 12/21/00 • Case Activity Listing 1/3/2005 g 12:17:38PM TIDEMARK Case #: SIT2OO1 -00009 COMPUTER SYSTEMS, INC. �: Date Dat o A , .�.. _ > SITC005 Application received 2/9/2001 None DONE DLH 2/9/2001 BLD SITC008 Permit Created 2/9/2001 None DONE DLH 2/9/2001 BLD SITC013 Plans Routed to Plans 2/9/2001 None DONE DLH 2/9/2001 Examiner BLD SITC015 Plan Rev. Ltr Sent to 2/13/2001 None SENT RDP 2/13/2001 Sent fax - Ofc Svcs RDP SITA018 Revised Plans 2/15/2001 2/15/2001 2/15/2001 None DONE JMT 2/15/2001 additional sets of plans to bob poskin Received JMT SITCO26 Plans approved by 4/2/2001 4/2/2001 4/2/2001 None DONE RDP 4/2/2001 CPE RDP SITCO30 Reviewed plans 4/2/2001 None DONE RDP 4/2/2001 routed to DSTS RDP SITC700 Erosion Control Insp None 4/2/2001 846 -8444 RDP SITC702 Excavation None 4/2/2001 RDP SITC710 Fill None 4/2/2001 RDP SITC720 Grading None 4/2/2001 RDP Page 1 of 3 CaseActivity..rpt t •- 1/3/2005 .„4111/ �� Case Activity Listing 12:17:39PM TIDEMARK Case #: SIT2001 -00009 COMPUTER SYSTEMS, INC. NICK .,......,,r. ice -rte ..;;�...�,,. "> Assi ned. � .;D ° da " ted ' ° x�•" rj �Y aJ :: ,i :l ivy, is ::Hold;' ,.�DIs' ;;To B'.;.,:;.: «,;a.`:� <�Nvtes„ , Descr ,... ; � . ,;� , SITC760 Landscaping Insp None 4/2/2001 RDP SITC799 Final Inspection 5/8/2002 None PASS HAP 5/8/2002 HAP SITCO32 DST Post - Review 4/9/2001 None DONE JMT 4/9/2001 Completed JMT SITC080 (F) Ready to issue 4/9/2001 None DONE JMT 4/9/2001 Message to Steve Kay, need JMT contractor information SITA070 (F) Ready to issue 9/21/2001 None DONE JMT 9/21/2001 called architect, steve kay, job just JMT went out to bid, should be picking up permits within a few weeks. SITCO50 Hold for 10/18/2001 None DONE DEB 10/18/2001 On HOLD pending approval from DEB CUP from both PLN & ENG SITC080 (F) Ready to issue 10/29/2001 None DONE DEB 10/29/2001 Okay to issue per Sherman's e-mail DEB of 10/26/01 SITC092 (F) Issue permit 10/29/2001 None DONE DEB 10/29/2001 DEB SITC775 Final Report Eng'd 4/12/2002 None RECD HAP 4/15/2002 Received final acceptance letter from Grading HAP WDY Engineering for water quality facility SITC775 Final Report Eng'd 4/12/2002 None RECD HAP 4/15/2002 Received final summary letter from Grading HAP GeoPacific Engineering for soils compaction SITC800 Case Finaled 5/8/2002 None DONE HAP 5/8/2002 HAP Page 2 of 3 CaseActivity..rpt Case Activity Listing 1/3/2005 g 12:17:38PM TIDEMARK Case #: SIT2001 -00009 COMPUTER SYSTEMS, INC. ,. ., ,, ;,,,; �Assined - > - -� � one -;,; . a e :���, a,, \�u F �,. P ,r ....... .�, .,,,,.;• "..::...:- .:, � �. , .. .. ".;,::.<.:,.. -. = •.: ,fig: * Date3 � Hold ':D`is o °B 1;:;•�, -. �.... ,,.. .. ,, ;• Date 2 ;..;..,.:. s :;,,.,• ;:.;•.. Act�vtt. , ;xF,.D t►on ,:- .;. ..�, ......., Date ... �,,,� �� .�� _ „ , '�� Y ...,,, ....,,.�..,�Y. � „� � ,,,� ",..:,�:� _�........ H- u�:, =°�;•, ,, e . -� SITA199 7/19/2002 None DONE JMT 7/19/2002 plans sent to records for JMT microfilming. PLM/SIT on same set of plans Page 3 of 3 CaseActivity ..rpt