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16455 SW COPPER CREEK DRIVE
CI i Y OF TIGARD SITE WORK
DEVELOPMENT SERVICES PERMIT
FDERMIT ##. . . . . . . : SIT97-0036
13125 SIN Hall Blvd.,Tigard,OR 97223 (503)639-417109/09/97
DATE ISSUED:
PARCEL: 25I1413A-12900
SITE ADDRESS. . . : 16455 SW COF'F'ER CREEK DR
SUBDIVISION. . . . : COF'F'ER CREEK STAGE 3 ZONING: R-7 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :94 JURISDICTION: TIG
-----------------------------------------------------------------------------------
CLASS OF WORK. . :ALTFIAV ING?. . . . . . . . . : N RESO. N9. :
TYPE OF USE. . . . :SF GRADING?. . . . . . . . :
: N VALUE. . . $ : 10000
EXCV VOLUME: 0 cy LANDSCAPING'?. . . . : N
FILL VOL-LIME: 200 cy SITE F,RE'Pl?. . . . . . y
ENG FILL ?. . . . . . . N STORM DRAINS?. . . : y
SOILS RPT REOP" : N IMF.,ERV SURF ACE - 0 s
Remarks : Phase 1: Rebuild water way with class 50 rip rap and backfill private
property.
Own-r: PEES --------------------
RICK BROWN type a m-,o_%n t by date recpt
16455 SW COPPER CREEK DR EROS $ 26. 00 JDA 013/09/97 97--299073
TIGARD OR 97224 ERP(--' 8. 45 JDA 09/09/97 97-299073
ERPIC $ 8. 45 JDA e9/09/97 97-299073
Phone #: 624-2706 PRMT $ 80. 50 JDA 09/09/97 97-?990'73
PLCK $ 52. 33 JDA 09/09/977 97-t":1.99073
Contractor: $ 4. 03 JDA 09/09/97 rel- ?99073
F & M CONSTRUCTION LLC
2831.7 SW MORGAN CT
WILSONVILLE OR 97070
Rhone #: 5: 70-0901 $ 179. 76 TOTAL
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Erosion Control
Tiga-d Municipal Code, State of Ore. Specialty Codes and all other Fill inspection
applicable laws. All work will be done in accordance with Final Inspection
approved plans. This permit will expire if work is not stared
within 180 days of issuance, or if work is suspended for more
than 188 days. ATTENTION: Oregon law requires you to fallow rules
adopted by the Oregon Utility Notification Cent,.r. Those rules are
set forth in OAR through OAR 952-MI-4484. Your may
obtain copies of these rules or direct questions to W by calling
15431246-9187.
Issi-ted by . .11 d1z Permittee F+/K avitic
++++f.•++•++•++•++++++•+++++++++++++++++-F•++++++++.++++++++++++++++++-4........++++++++...
Call 639-4175 by 6:00 P. M. for an inspection ;,seded the next bi-isiness day
++++++++++++•++....4.+44....+++++++.+{.++++++++-4•+++++++++++++++++-f+.............++++++
49••0.9,17 EU 10:05 FAX 507 395 190n CITY "IF TIGARL /
CITY OF TIGAR® Site Permit Application (a
13125 SW HALL BLVD. QM-M-Qrcial: Complete ENTIRE form Pldn(:hint* 9�
TIGARD, OR 97223 N�sldenr,�: Complete SHADED areas Date Rc,d
(603) 639-4171 x,304 nate to P.E.
note to DST
Peri*rk 7
Print or Type Called —
Incomplete or Illegible applications will not be accepted �!
Project Nam UtltiUes(Complete All that apply)
Jobs `_ Alk- t"o�
Aftess ddress Storm Srtwer --
___ Linear Ft-
Name
Sewer
k .K -4 vW/1l --
Owner Maiiing Addreas Linear Ft.
Fret:n Water �'--
J.b�S �_.CO `12t�tF Ltr�aar Ft.
City/State ip ;ri: ci., Catch Basms —------
to
Gennrtri '� Clean outs
Contractor i leiuling Adtlresa(PrIorto o DeeuIbe work ;o-de—(j orer:
leeuenc* Newt Addiban[ Alteration❑ Repe►q
opt,iicent rnuat _ -- _ 1
prmlft�t city tJlte Zip FPh Additlonal Descn i of Work. — r
ab000ttw= State onsL �'bo rb d Lic,#- Data
ueer»e _ �at �EOoU C REInI F�KCE Q
mrnrmationn COTgusines;�Tp orMstro0 [X
urna,anaAA) -Date -- W•1 } 0AAARR4 'ROCK
----- Name ---� _'__. ,
Valuation g ��� Y�yfk�u.SANe7
Architect Moiling Address 71411116 Reg d: Sae Matrix on bnnkF
Thafollo)Mna mutt accornpsdny this application: j
CityJShste-- - Zip Phcne ite plan with Vicinity Map i Parking(i iciuJinq
—`__ Showing ADA_compllance ADA)8 L)ghtin Plan
Nrame Grading Plan end detaaa — Landacapinp Man—
Englneer Mailing Address --- —
Erosion Control Plan and Retaining Struure9�
! (i218115 _ nClucir)rj Cd u kt ul s
CI�y/Slate Zlp Phone Site Utility Plan and_detailo Saila Reporl
(showing connection to !if nmquired)
appruyv aystern
EXCAVHIIOn VDIUmP hemi y w*nnwitNlgp ryes i have read this applicaunnTn
, attno --1
(Soils report required for,5,000 cu.Yards into,fnatian given's cOrTect,that I am the owner or authnnzpd
CU.yds. agent of the owner,and that pians submitted are in compliance
wtn Orogen State lows
Fid Volume Signative of Owners it para
{Soils repos required for X8,000 cu-Yds.) ,r,.�–-----.
W8 the fill support a structure orttact person Name
(Engineer required d answer is yes) YESO Nt , ZQ 77pQ,
ketainrng R rurlure (rheck nrl ode >J�< ?CJs' f � Acv,
FOk OFf=ICF:
US
E;ONLY
MU Note,:
QConaele
[J01hor
Total new Impervious area Including W. Lautd Use Case 0 _ b1apRW
buildings,sidewalks,and paving _� b( r 5q. Ft.
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F M CONSTRUCTION, LLC
28317 SW Morgan Ct.
Wilsonville, OR 97070 CC641. 1zm
(503) 570-0901 --
FAX (503) 570-86.53
FRCP SAI, NU CONTRAC T
CUSTOMER:
r�� —
PROJECT NAME: NF-CY �A4__ j K_V C_o NS+RU C-kU4_
PROJECT OWNER:
PROJECT LOCATION: FM`
1VORK: F& M CONSTRUCTION, LLC ,hall furnish labor. materials and service necc,,sai v to complete the following work 1-W4 , r.
ERbmi-) CIPEEKBA-AlK. AiJD -kAcL- QURERy ROCK -To ELIMINATE
kaR�-��ER ERosidm.
2) 5-bCK'pu'E SEES on! MPER4V ti*' rJEEO - to -aE i F--hA6VE7, 1.
Fo R -tEMPORPy EP03(o r, Co&-Rdl.
ZiMvJAA._k W I ff -344 --"-'1LVW006 -To W--LP �R.EVF_.nf+ CRR(KjA* FRoA TRUCKS.
5� FSM Co IISFRL�ChchlfLLC Wll( X10+ KF- NELf) LiAW- FOR hAeEMEd4 eK TS#r)Q E,F
C12AO(F-h -�,4DEWRLY-5� LAA/4:S ,:IIAJyl�'I"y J OR 7VE.&-S1 C Zl)lSt OR PE-5666In14 eF
CREEK PANk.
Unless specifically stated otherwise above. the Work does riot include permits, fees.assessments,soils or materials testing,surveying,
geotechnical services or civil engineering.
CIT IV OF TIGARD BUILDIIiG INSPECTION DIVISION ��' _
2 -Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
BUP
1-� � _ ate Requested_ 67 AM —PM / _ BLD
Location `
Smite
CkContact Person .0 t LUI�� Ph
PLM
Contractor - _ Ph 570:1 )� SWR
B IUB IU LWNG Tenant/Owner ELC
Retaining Wall ELR
Footing -
Foundation Access:
Ftg Drain 3dC./�
'le. - �4 ��i� / J � VPS
Crawl Drain Inspection Notes: G U� SGN .
Slab SIT ,
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation ---'
Drywall Nailing -------- _
Firewall ---
Fire Sprinkler
Fire Alarm -- - --
Susp'd Ceiling
Roof ---`-
Misc:
Final --
PASS PART FAIL _
PLUMBING
Post."A 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 -- - ---
Servicc-
Rough --- --�.. ----- -- --- —�-.
UG/Slab
Low Voltage
Fire Alarm
Final
PART FAIL --.__ ---- -- - - —, ----- _ -----
$I
Backfill/Grading - --- -------...._ _—_`
Sanitary Sewer Q(
Storm Drain I, Reinspection fee of$— _required before next Inspection. Pay at City Hall, 13125^IN Hall Blvd
Catch Basin \
Fire Supply Line [ ]Please II for reinspection RE_ [ J Unable to inspect-no access
ADA \� A
Approach/Sidewalk pate /_ 1
AAGRh",T2Inspector __ _L,_ - - Ext
PAS PART FAIL DO NOT REMOVE this inspection record frot,n the job site.