Permit ',CITY OF TIGARD SITE WORK PERMIT
i� DEVELOPMENT SERVICES PERMIT # : SIT2004 -00007
`�'` . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED : 3/10/04
SITE ADDRESS: 11355 SW TIGARD ST PARCEL : 1 S134DC -00600
SUBDIVISION: ZONING : R -4.5
BLOCK: LOT: JURISDICTION : TIG
CLASS OF WORK: NEW PAVING ?: RESO. NO:
TYPE OF USE: COM GRADING ?: VALUE: 500.00
EXCV VOLUME: 10 cy LANDSCAPING ?:
FILL VOLUME: 10 cy SITE PREP ?:
ENG FILL ?: STORM DRAINS ?:
SOILS RPT REQD ?: Y IMPERV SURFACE: 440 sf
Remarks: Site work for installation of cell tower.
Owner:
FEES
Description Date Amount
[BUPPLN] Pln Ck -Valu 3/8/04 $40.63
[FLS] FLS Pln Rv 3/8/04 $25.00
Phone: [BUILD] Prmt Fee -Valu 3/10/04 $62.50
[TAX] Valu 8% State Sui 3/10/04 $5.00
Contractor: [ERPRMT] Erosion Cntl 3/10/04 $80.00
SCHOMMER + SONS INC [ERPLN] Ersn Plck -USA 3/10/04 $26.00
6421 NE COLWOOD WAY [EROSN] Ersn Plck -COT 3/10/04 $26.00
PORTLAND, OR 97218 [WQUAL] Wtr Qual % 3/10/04 $225.00
[WQUANT] Wtr Quant ° 3/10/04 $275.00
Phone: 287 -4646 Total $765.13
Reg #: LIC 4937
Required Inspections
Ersn Cntrl 681 -4444
Fill
Final Report Eng'd Grading
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: jl ,
Call (50�+�•39 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Work
Building Fermit A IIC 'RECEIVED � ' . FOR OFFICE USE ONLY
•
City of Tigard LIAR g 200 Received . J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: D 503.639.4171 ' Fax: 503.598.1960 C►TY OF T► J l' B .• Date 0'0 ■ ) l Other Permit
Inspection Line: 503.639.4175 3t' _ .. Date Ready/By ® See Page 2 for
� - � y '
Internet: www.ci.tigard.or.us BUILDING Notified/Method: , Supplemental Information
'"' - - ` -", '--:'-; ;-. - '''' , k - TYPE-OF `.WORKS , =,' "^ RE UIRED DATA: 1 =AND 2- FAMILY DWELLING:"
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 he
=- ?r work indicated on this application.
- , _ -"' '- "" a :: - ' " : 4
_ ,.. ... ., iz% x - _fi .. rx•_.. s _ ..,; ,. .�k.. - .Nn , ._, - . "h, a ns .,. : ,.
❑ I- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
';*'''-'4',5:7 SI . - ° f" ' ` ' Total number of floors:
-? dOBa " INF 'A
, ,,,, ION . ,,- ,OCATION `1„ ` :i
, 1 N" ,
Job site address: \V"rj55 5- -1, . , II: 't-Q iL� New dwelling area: square feet
11
City /State/ZIP: - - 7 ., ` c. k . CZ. Ck Zz3 Garage/carport ,. ea: square feet
Suite/bldg. /apt. no.: Project name: paz., ec_f(.3 Covered r .rch area: square feet
Cross street/directions to job site: C,q A(5 D - • area: square feet
Other structure area: square feet
a REQUI( RED DATA: =COMMERCIAL -USE CHECKLIST.;
Subdivision: N3 P ■ I Lot no.: Mc, 00 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
3 " "-- DESCRIPTION ,OF WORK = .. = "':%'. work indicated on this application.
In.3�aaNCLA:COQ °e, (i)O - Kl t' l r.� ■ kolas �Ot0t_
Valuation: $ , Cj °o
0.AA CTZ 1. �} S- � f , w Existing building area: square feet
New building area: square feet
CIPROPERTY OWNER , V` ,:
Asa ; � -���`� ` a`�`', . +�'t`,;. . � 3 -, , .'. : . Number of stories:
,
Name: La . k - . I '. • Type of construction:
Address: l o r _ , ` f rei ct , Occupancy groups:
City /State/ZIP: • I I 0i. I Existing:
Phone: ( ) . Fax: ( ) New:
PLICANT = -=' -: 0 :`CONTACT PERSON f
Business name: \) Q - M 1 (`� .j5S . All contractors and subcontractors are required to be
Contact name: S O(oh{sa__ ' 1t+\���(�S 1 %,),) All
with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: VI 5 - -D 3 l.t.30. cLr jurisdiction in which work is being performed. If the
City / State/ZIP: ��� cR + 3 �j applicant is exempt from licensing, the following reasons
apply:
Phone: C503 ) °173, S'V4( I Fax: : ( q 13 , 3\4.513
E -mail:
'` K4711 ::- ;CONTRACTOR:`` ' r ; = ., f ^
Business name: „ 1 L01 1 lie �/s�L� ;,; ..,.. ' .> ; . :�a
o �' �` � . = "'BUIL;DINGPER)vI , ;e;
Address: L p 4 2 i N c. oo l v , ( o 1 w Please refer to fee schedule.
City /State/ZIP:4 r9
® 1 r ( az L
1 Fees due upon application
Phone: (603 2? F -Lk.P4 L.P Fax: (6 03) 28Z7 1:RC:1
4q��- Amount received
CCB lie.:
Date received:
,tizeti
Authorized signatur . This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: cc-y- ► Li e �/ • Date: 3 / $ / * Fee methodology set by Tn- County Building Industry
�i� t L( � � Service Board.
lAuuddmg \Pcrmils\SIT- PcrmnApp doc 12/03 440 -46 I 3T( I I /02/COM/WCII)
- , City df 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: 10 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) I 0 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be
compacted to 90% of maximum density) 10 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
n ❑ Concrete
❑ Other:
*Total new impervious area including all
buildings, sidewalks, and paving: 44-0 sq. ft.
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.
�� zi,�� . o ans .
::T:YPEOFwSUBMITTAI `' :: ` Re uired ate' R
A' °Submittal- ^, . •
licludes;:" New - Addtions�or �Alterations�
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
is \Building \Forms \SIT- PermitApp.doc 1/13/04 2
EROSION CONTROL NOTES: 6\
1
1 . O OF DESIGNATED •
PERSON SHALL BE RESPONSIBLE FOR PROPER
W
' 1 In INSTALLAIIGI AND MANIDUMCE OF ALL EROSION AND SEINE NT CONTROL �. -
g MEASURES. Di ACCORDANCE WITH LOCAL, STATE. AND FEDERAL REGULATORS. de
B ti
e N 4.-0' g1 I 2 THE OD'LFLDRTADON OF MS ESC FLAW AND NE OG6DNC EN, WMIDUNCE, o g m
r -6' ,•,;( dd c Ps CITY OF TIGARD OF ,Iff NT ""D / " � P N G`"°dG �`
N , y S S ire W O Ii i AND APPROVED Am Y£O Al li LD ALL S FSTA6L19 ®
. Tiff DEUELOPEER o: ._
A �� LOTS F WLd11D1A MIER 1HE PROECT IS APPROVED a C
i. me' Approved ( ): p e
h Q 1 THE BOON DARES OF THE CLEARING TH
G LOOTS 91001 S PLAN SKULL BE ° W W
For only the WU aS described in: CLEARLY RIMED N THE RID PRIOR TO CONSTRUCTION. DURING 1HE ; 4 z o:
0 ' 6 �' tl i PERMIT NO ' L D 0 4 �- d 0 0 D ' - CONSTRUCTION PERIOD NO GSNRBAICE BEYOND THE RAGGED WARPS
a.
■�G� � , UNITS SHALL minim. nim. THE 'mawS SHALL BE MANTAIN D BY THE g -
�� W APRICANT/CONTRACTCR FOR 110: DURATION OF �' 8 Le
See Letter to: Follow
= 2 Y
4. 11E ESC FAC0J7E5 910811 ON THIS PLAN MUST BE CONSTRUCTED N
P O ° - W
f3 «<
g Z 4 a ., 4 Attach p. � ( ): A AS CONJUNCTION m � THAT sm�umNr AND s LADEN wA1ER
Job Address: / / 3 S� w —' Ti 6A1L!) 577 A
� � � By: 151% 114/ Co LA LO lc Date:t /O-Y WATER RS'TTAND ME DIUNAGE SYSTEM. ROADWAYS. oR VIOLATE APPLICABLE
S. THE ESC FACADES SHOW GM THIS PLAN ARE ME MINIMUM REOUIRFNa its i
FOR ANRCD'A1ED SITE CONDITIONS DURING 11# CONSTRUCTION PERIOD CF
1 - I THESE ESC FACILITIES SHALL BE UPGRADED AS NEEDED FOR UNEIIPECIED
I
STORM EVENTS AND TO ENSURE THAT SEDIIBNT AND SEDIMENT LADEN p . NAIER DO NOT LEAVE THE SITE. 99
may \� = ■ 1 HmIOES 91ALL NSECIED P 1NE AN 1 6. T
I CONTRACTOR E ESC FA AND YANTADBD BE AS NECESSARY DAiY TO BY ENSURE APPLIC THEIR T/ mum
— / S
■
FUNCTIONING
o ............
% I • I 7. AT NO 101E SHALL SONDE BE ALLOYED 10 ACCLIMULATE MORE THAN
............
............. ■
............
BARR IB IGIT ALL GTCH BASNS A16T CONVEYANCE lMf3
......... 13 • 1 I 1 ALL CLEANED PRWR 1D PA THE CL EANING OPFRA110NS SHALL 0
........
.........
......... 3
:::::::� t W------- - - - - - - -- NOT FW91 SIDOBNT -LADEN CORNER N1D THE DOMNSIREAM S1S1EY. w
5 _ I a STABILIZED GAVEL ENTRANCES SHALL BE INSTALLED AT THE BEGBOING '�01 I
'';;: %\ ' s H 0 u si / ; > 1 ■ • • I 11 s I AD ADDI IONAL�MEA J1 SS MAY BE RE 1 N THAT THE PROICI < • I N
;:. $ Z < W — i I' ARE KEPT CLEAN FOR ME DURATION CF ME PRO,ECT. z o c
o = O ° Q 1 �. I Y INLETS BASOS DS BE ROTCT i N 6 i J 210 A STORDRAIN AND AREA DRA PEED ..6 `J�'
,� ■ d =
I , i , , 'ra , RE- ESUBL19iED.
■ ii /� _ w�WL II D'� to PAVEMENT SURFACES Me VECETAltG1 ARE TO BE PLACED AS RAPIDLY
w 99
�i „� ' 11. SEEDNG SHALL BE PERFORMED NO LATER THIN SEPTEMBER 1 FOR EACH Nn a- o
r ' — I �`� 1R / PHASE OF CONSIRIICIION.
6' / -- _ 1 - .ry . . _;� - ��.�'- OCTOBER 1ST THROUGH APRs 3
1 12 IF THERE ARE OROa1D =as OR was NOT FULLY ESTABLISHED FROM
6
SET MEANER EROSION PREVENTION
< , MEASURES WILL BEN EFFECT. SEE TTHE EROSION PREVOITIGN AND SEDIMENT
p� o+ ,` �� CONTROL PIAI/1NC Am DESIGN MANUA RE PRR 4) FOR REWQEICENTS.
O . Fr o
a li I ' f 1 ", ar a t r ` s� t •I• '- s! •,— I 11 HILLY DEVELOPER STALL REYOUE ESC YEA51JREs WIBTI VEOETA110N 6
4 . -
• L r } �.K: T tv ' 1 1 s ' e'..-,-
1 FULLY ESTABLISHED. SEDIMENT FENCE Detail Droning 4-16 I , y a ~` }f <1 g 4 .:5z;,,_.: T y • `_ * 1 2sob ( ;
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Page 4-81 c . : -, •- I • 1 ,- Sil- 1 r : x '''.= INSTALL TA FENCE !J 1 A .--.1 1 . % t tr l' - ' PER DETAIL 16, 1 \ __ t• Q CC
I : i ;" � . 1 7 :.'F'^', - . - 7,' - i•.: ' , I 1 I- j' • - THIS " - j il 1 ■ - R '; *IN Zr) 0 0 w
Y BE USED SNORT 11:911 r /^
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TAX LOT 700 ; �}; f, • 60 1 ® / , W
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rii1 INSTALL SILT FENCE 1 u , I 1 93 1 ii
- 6 ' ewlap el Daga PER DETAIL 4-16. THIS SHEEN 1 A�': 1
VIEW I 11iilil, .` eC 0'1E,, j NST 1 1 1 '
PLAN VIEW IVil!:, NSTALL BLOBACS ALONG EK. DITCH '— BTOBAC PROTECTION SWAG PR
PER DETAIL 4-24, THIS SHEET. 1 EX CATCH BASH. PER FOR • ETCH BASIN 1 a�. 1 1
R ,1,.., T AIL 4-24. THIS DET,4- U9 0.....____
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DITCH INLET ,_L____ 1 riot /90 • — — Lo r4
NOTES , ww •••• ■m �Di • a - ° c 'es ... 1. ADDITIONAL MEASURES MUST BE ��• - -
- - - `�o_ _ - •' O n c‘i in
SOIL PE
TYS - - - - -�
CONSIDERED DEPENDING ON S _ 189 2. SOFILTER BAGS SHOULD BE STAKED •'' f -- --- -- - - - -- ••
Qp
*ENE APPLABLE U9NC 2 VE d ------- - - - - -- - -- OFFICE COPY Of) • O
YYDOD STAK OR A� EQUAL PER BAG. � . � �.. •�
1 18 M
INLET PROTECTION
Detail Droving 4-24 ) N , . ' ,
TYPE 4 U
i Page 4-109 EROSION CONTROL AND GRADING PLAN: SW TIGARD ST
I I I
'ii
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 , ; 4 T. 175
INSPECTION DIVISION Business Line: (5.. ' 1 MST
6/3 a./4 Am Received Date Req T d AM PM BUP
Location t l c ��' % Suite `` I MEC
Contact Person Ph ( ) al ? T7't S PLM
Contractor /n� AAnn h( SWR
BUILDING Tenant/Owner VJe. b 15\71 % LC
Footing
Foundation ELC
Access:
Ftg Drain , 14 y _ 6 a 0 c ELR
Crawl Drain 2 0 f 00667
Slab Inspection Notes: V
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm \\
Susp'd Ceiling
Roof
Other: I Final
PASS PART FAIL
PLUMBING
Post & Beam /
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
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 D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PA.. PART FAIL
TE' Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date �j�b Inspector Z Ext
Other
DO NOT REMOVE this inspection_ record from the Job site.
ASS PART FAIL