Permit • CITY OF TIGARD SITE WORK PERMIT
1� DEVELOPMENT SERVICES PERMIT # : SIT2000 -00053 •
4J1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 1/4/01
SITE ADDRESS: 12120 SW SWEENEY PL PARCEL : 2S103A6 -05400
SUBDIVISION: WALNUT GLEN ZONING : R -4.5
BLOCK: LOT: 012 JURISDICTION : TIG
CLASS OF WORK: OTR PAVING ?: RESO. NO:
TYPE OF USE: SF GRADING ?: Y VALUE: $6,000.00
EXCV VOLUME: cy LANDSCAPING ?:
FILL VOLUME: cy SITE PREP ?: Y
ENG FILL ?: STORM DRAINS ?: Y
SOILS RPT REQD ?: IMPERV SURFACE: sf
Remarks: Construction of retaining wall on residential lot.
Owner:
FEES
STEVE WELCH
12120 SW SWEENEY PLACE Type By Date Amount Receipt
PLCK CTR 12/4/00 $65.59 27200000000
PRMT CTR 1/4/01 $100.90 27200100000
5PC2 CTR 1/4/01 $8.07 27200100000
Phone:
Total $174.56
Contractor:
MOUNTAIN STONE CONSTRUCTION LL
8805 SW GARDEN HOME RD
PORTLAND, OR 97223
Phone: 503 - 246 -3077
Reg #: LIC 124854
Required Inspections
Strm Drain Insp
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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503) 246 -1987.
Permittee Signature:
Issued By:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
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Date received: /,Z% 7'OD Permit no.:5'j - . &v63
..41: :t., ��.
4,.. 1 City of Project/appl. no.: Expire date:
City ofTigard Address: 131 L.3 a vv nau v
DIVU, isgaru, n 7r cc.3
Phone: (503) 639 -4171 Date issued: EJ Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: l &2 family: Simple Complex:
TYPE OF PERMIT
f 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family ❑ New construction ❑ Demolition
�6 Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: l . i . 0 5 ,-- S t"r e e t-c Q • P L., Bldg. no.: Suite no.:
/ Lot: i Z I Block: 'Subdivision: 1,01.4 (- di /e ti - 'Tax map /tax lot/account no.:
J Project name:
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: S, r LY e e C y (Floodplain,septic capacity, solar, etc.)
Mailing address: / 2.1 2 n . g J flv-'c' i r `t? pi, 1 & 2 family dwelling: f
City: 7 / 4 G1 'State: d e 1ZIP: Valuation of work $ CI 6
\ Phone. Fax: 1E -mail: No. of bedrooms/baths
\ ,,t Owner's representative: Total number of floors
=Z` • Phone: Fax: E -mail: New dwelling area (sq. ft.)
;L APPLICANT Garage%arport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: 'State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E- mail: Commercial/htdustrialmulti- family:
CONTRACTOR Valuation of work $
..,L.; 7 - d hf� Existing bldg. area (sq. ft.)
Business name:
,Me v 7 ' � � � � New n bldg. area (sq. ft.)
y Address: - a 5 5 / �� ..-/4 /-Ellyn rPd .
City: " <I State: e, 1 ZIP: `j 7 2 y3
Number of stories
C '
Phone: 1 Fax: 1E-mail: U M u C to ✓, a Type of construction
, Occupancy group(s): Existing:
CCB no.: / 2. 5/ g S y A/C 7 New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: Ste I ZIP; exempt from licensing, the following reason applies:
Contact person: 1 Plan no.:
Phone: Fax: E -mail:
ENGLNEER
Name: Z- o v /' J .e h7.. G -1-'1 Contact person: P ► /e. Fees due upon application $
Y Address: I/ 6 / _ (7 e ✓ 2 /-/ - Date received:
City: f' H f 'State: C3 ZIP: 91 L. a/ Amount received $
Phone: z . 2.1y - 41173 Fax:,.,./'/ SS 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 laws and ordinances governing this U Visa Cl MasterCard
work will be complied with, whether specified herein or not. Credit card number: Authorized signature: u es
�'-'•— ate:/ - . ' d U Name of cardholder as shown oo credit card p
,, /
Print name: / 0 / I/ '25- St 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 (6/00VOM)
dCP /0.p
fel.
SITE PERMIT CHECK LIST
Commercial and Multi - Family: Complete ENTIRE form.
Residential: Complete SHADED areas only.
Excavation Volume: cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) cu. yds.
Retaining structure? (Check one) Li Rock
❑ CMU
❑ Concrete
❑ Other
LI
Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Utilities (Complete all that apply)
Storm Sewer: Linear Ft.
Sanitary Sewer: Linear Ft.
Fresh Water: Linear Ft.
Catch Basins: #
Clean Outs: #
Plans Required: See "Application /Plans Submittal Requirements" attached.
The following must accompany this application:
Site Plan with Vicinity Map Parking (including ADA) and
showing ADA compliance Lighting Plan
Grading Plan and details Landscaping Plan
Erosion Control Plan and details Retaining Structures
Site Utility Plan and details • • Soils Report (if required)
(showing connection to approved
system)
i:\dsts \forms\sitechecklist.doc 10/05/00
/•3 74- des •
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested / —Z3 AM PM BLD
Location /Z/ Z-4 5 641 fw 'Ai 7 P ( Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
t3UIL Tenant/Owner ELC
.._„�
ELR
son Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab
Post & Beam SIT 3
vv — v G s
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall�
Fire Sprinkler l QS 1 ca IvS1Vcw.b •ks
Fire Alarm
Susp'd Ceiling 6 NI S TQ
Roof
Misc:
c� PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please II for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Z3 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspecti n record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION M
24 Hourinspection Line: 639 -4175 Business Line: 639 -4171
UP
lg / / ,l
�
Date Requested 1 IsVif AM PM BLD
Location / 2-/ 2.6 Suite MEC
Contact Person U'D Ph PLM
Contractor Maul '? II` CO-vt e7A Ph 41) 2 4 3 oil SWR
BUILDING Tenant/Owner 5 ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes
Slab "` y A � L d ,.,64/}/K � S ' SIT IT
/In - 006
Post & Beam
Ext Sheath /Shear i
Int Sheath /Shear ✓► /�
Framing + t� l /l) ✓�� /l `
�. S !�`/\ S .
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 11. ...i/
Fire Alarm
%MN / /'
Susp'd Ceiling jCor ' L. (4,-\ •
i v
Roof vfil \ S
Misc: T v'"
Final Q
PASS FAIL a `^-"'
PLUM = - L (�
Post & Beam
IC�
Under Slab
IIJJ
Top Out
Water Service • . ,, / 0.0-/Y"'C ---%/ S 1 1
ry •
Sanitary Sewer :
6
Rain Drains e t ° ` _ % _��,
Final / —41 '�"
PASS PART FAIL . ✓-
MECHANICAL if tt 1 ^ �` l `�
Post & Beam �'/
Rough In C Le-- (-t) : 4-1 \
Gas Line
Smoke Dampers
Final `" �`r & .
PASS PART FAIL
ELECTRICAL
---) Service
Rough In
UG /Slab _ Y.� 25 (1 ��
Low Volt J
Fire Alar m 0,w `�
Final 1"L .Ql— � E - ' `�/\
•
PASS PART FAIL jk� \ ®V
SITE e „„ S 4C4 12.AA ( r . s...4"—QQ_Ar 1/4-...- , Backfill /Grading
Sanitary Sewer U
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin /
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date l ate \ O / > l InS ector `� C/ ) EX IC I
Other P
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.