Permit CITY OF TIGARD SITE WORK
i�
,,,,,R 0 DEVELOPMENT SERVICES PERMIT
PERM �I�� 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE 09/19/97 -0003
PARCEL: 2S1O2BD -02600
SITE ADDRESS...: 12925 SW PACIFIC HWY
SUBDIVISION • NORTH TIGARDVILLE ADDITION ZONING: C —G
BLOCK • LOT •037 JURISDICTION: TIG
CLASS OF WORK..: NEW PAVING? • N RESO. NO.:
TYPE OF USE •COM GRADING? • Y VALUE...$: 20000
EXCV VOLUME: 0 cy LANDSCAPING? • Y
FILL VOLUME: 0 cy SITE PREP? • Y
ENG FILL? • N STORM DRAINS ?...: N
SOILS RPT REQD ?: N IMPERV SURFACE: 250 sf
Remarks: Footing I sitework for 80 ft. tall cellular communications monopole,
fencing & 240 sq. ft. modular bldg. with related (minor) sitework
Owner: FEES
ROSEMARIE EMERY ESTATE type amount by date recpt
12925 SW PACIFIC HWY EROS $ 80.00 JSD 07/24/97 97- 297509
TIGARD OR 97223 PRMT $ 140.50 JSD 07/24/97 97- 297509
5PCT $ 7.03 JSD 07/24/97 97- 297509
Phone #: PLCK $ 91.33 JSD 07/24/97 97- 297509
SWM $ 180.00 JSD 07/24/97 97- 297509
Contractor: SWM $ 100.00 JSD 07/24/97 97- 297509
CORD COMMUNICATIONS INC
1065 ELM ST
SAN JOSE CA 95125
Phone #: 598 -0800 $ 598.86 TOTAL
Reg #..: 001035
REQU IRED 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 Final Inspection
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 952-081-0810 through OAR 952 -001 -0080. Your may
obtain copies of these rules or direct questions to OJNC by calling
(503)246 -9187.
Issued by: Permittee Signature: ink
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + ++ + + ++ + + + + + + + ++ ++ + + + + + ++ ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + ++ + + ++ + + + + + + + + + + + + + + + + + + + + + ++
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CITY OF TIGARD Site Permit Application Plan check 1-4 /,3
Racd By
13125 SW HALL BLVD. Private Grading, Paving, Site Accessibility Date Rec q1 '
TIGARD, OR 97223 Retaining Structures, tilities a d Related Work Date to P �g.
(503) 639 -4171 x304 .. Date to DST t
a 1 J� fill Permit ft -- r" 7 9 '7-
4 4 • • v e I wr V • ' Called
'' ri • t or Type ' .. Incomplete or illegible applications will not b _F cepte. 4 ,. / ANA I .
, - , -
- � P - roject Name Utilities (Complete all that apply) I
Job
I I ii/Q'i (; Uu)L S l I ( P PP Y)
Address Address
J 1 2426 $ f * -P C 11 WY
Storm Sewer
[ I Linear Ft. +
Name Sanitary Sewer
5 1A7 7, - S T Linear F'.
Owner Mailing Address Q Fresh Water —
I 0 5 5w 1 k'I G-N Linear Ft.
City/State Zip l Phone Catch Basins
Name Clean Outs
General CO- COMMUOJI Ct nolo5 , I JC. #
Contractor Mailing Address Describe work to be done:
(Pncr to
New0 AdditionliAlteratiOnC Repairr
issuance -9 l o 6 JW 'Iv. Loop ( cu I ( Z
applicant must C i fate Z� P hon e Additional Description of Work: -A t-tOyIl t �l'tlOt
provide au 'p � ' n� q � T o� g Q d o Q -1 SH1SS10WIzt ull,2, Sf t Fv( (ZTducH ( Atli 0
an contractors state Zonst. Cont. Board Lic. # Exp. Pate p� 66)4ST9. of .J UNOCG() P Dl uift1±✓t.Jrlivit,�a l
"1
license I J 5 4 U 2.76 g / G� / A- ort1.1VA-S 00 ((J) M01.J0po , . --*Jci k 1 Glarti , frtpld
ntormanon.n COT Business Tax or Metro # Exp. Oat L1p-(CAl` l P1 unLr(Y ovwec er4
COT catacasel dF t1 l CR MLA, gE - AT - n s ! .
m S �JO r-Lp (D►J T1OH (tJc.
Project C O- O'D $ _ ice`
1 Valuation O �' U'V C' —; " " - •_•.
Architect I Oo Mailing Addres " #- (6 Plan Submittal: (3) sets containing each of the
Zip following, must accompany this application:
• I City /State Zip Phone Site plan with Vicinity Map Parking tinc:uding
� 1 X ' fib 3� 1 6 5 OZ e 9 Showing ADA compliance I I ADA) & Lighting Plan
I Nam e t Grading Plan and details Landscaping Plan
Engineer Mailing Address Erosion Control Plan and I Retaining Structures
r, ' details including calculations
City/State Zip I Phone S:te Utility Plan and details I Soils Report
i (showing connection to require)
acprcved system)
Excavation Volume : herecy acknowledge that I nave read this application. that the
(Sods report required for >5,000 cu. Yards :nforrration given is correct. mat I am the owner or autnonzed
Cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill .clume I I Signatur- of Owner /Agent I Date
(Sctis report required for >5.000 cu. Yds.) _
WI! ! cu. yds. I 'A ' / I I/7i3 /�
the fill s upport a structure Contact Person Name j Phone
I (Engineer required if answer is yes) YES,1 NOD
TU I / IO 75-.ZM
Retaining structure? (check one) I [Rock FOR OFFICE USE ONLY
C CMU I Notes:
CConcrete
"'Other
i � Tota new impervious area including all Lar U C # MaplTL#
q •.
I buildings. sidewalks. and paving 21 S Ft ' '�f v �'�� I
I: csts\siteapp.dcc
3 /S6
Permit It- Account Description Amount Amt. Pd. Gal, �- Due
5Ffl l 000 P ermit (BUILD) II—I rgC �" ,/(`k2
J
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELCIELR Permit (ELPRMT)
State Tax (TAX) - 7,03 - 6 /7, 63
Bldg:
Plumb:
Mech:
ELCIELR:
Plan Check
Build: (BUP LN) , 33 / 33
Plumb: (PLM LN)
Mech: (MEC LN)
CDC Review (bi N US)
Sewer Connection • _ (SWU - • )
Sewer Inspection (SWI SP)
Parks Dev Charge (PKS'C)
Commercial TIF (TIF )
Industrial TIF (TIF I)
Institutional TIF (TIF IS)
Office TIF (TI -0)
Mass Transit TIF (TI' -MT)
Water Quality ( QUAL)
Water Quantity QUANT) fib %r
Erosion Control Permit (ERPRMT) 1 HD
Erosion Planck/USA (ERPLAN)
'
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
TOTALS: 9 ° 590'
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Page No. 1 CASE HISTORY FOR CASE NO.: SIT97 -0003
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CORD COMMUNICATIONS, INC
12925 SW PACIFIC HWY - -
11/18/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- - -- --- -- -- -- -- ---
SITA005 Application received / / / / 01/23/97 RECD JMH 02/27/97 J *H
SITA008 Permit Created / / / / 01/28/97 DEBATE OVER HOW TO PROCESS. FORWARDED TO MEMO JSD 02/27/97 J *H
JEAN H.
JEAN VERIFIED WITH JIM F., NEW PROCEDURE
REQUIRES SEPARATE -SITE
PERMIT. (ORIGINALLY TOLD TO PROCESS AS
ONE PERMIT PER DAVID /JILL,
BUT WITH TWO APPLICATIONS, FOR
INFORMATION PURPOSES.)
SITAO10 Check for prcl. restrict. / / / / 02/27/97 - MR 02/27/97 J *H
SITAO11 DST /mai•1 Land Use Condition Lt / / / / 01/28/97 MARK REVIEWED PLANS, HIS ONLY CONDITION NONE -MR 02/27/97 J *H
WAS THAT PLANS WERE TO BE
PRESENTED TO HIM - PRIOR TO BLDG PERMIT
ISSUANCE. MARK APPROVED PLANS.
SITA013 Plans Routed to Plans Examiner / / / / 02/28/97 SEE NOTES FOR DELAY OF ROUTING. JMH 02/27/97 J *H
SITA030 Reviewed plans routed to DSTS / / / / 07/15/97 APPR RDP 07/15/97 RDP
SITCO32 DST Post- Review Completed / /- / / 07/24/97 Plans reviewed by Mark Roberts and he PASS DRA 07/24/97 DRA
approved issuance.
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SITCO8O (F) Ready to issue / / / / 07/24/97 Cord Communications needs to obtain a PASS DRA 07/24/97 DRA
City of Tigard Busniess Tax as they are
a Tigard based business.
SITCO92 (F) Issue permit / / / / 09/19/97 JT 09/19/97 JD
SITC724 Retaining Wall /Footing / / / / 09/22/97 foundation for cell site approved PASS TLP 09/23/97 J *H
SITC799 Final Inspection • / / / / 01/16/98 PASS GS 01/20/98 J *H
SITC800'Case Finaled / / / / 01/16/98 - PASS GS 01/20/98 J *H
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