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APPLICATION - STREET IMPROVEMENT/EXCAVATION COPY TO:
\ LK (WHITE)-FILE ,
ORDINANCE NO. 74-14 �• �] (YELLOW) -IN!iP,
~��I • (FINK)-OTHER AGEIVC1�j1C .
(INSTRUCTIONS ON SEPARATE SHEET) P� (BLUE)-APPLICANT
1 APPROVED (� APPLICATION NO.: _ 41� ----
NOT APPROVED (] ('TI'Y C)FfI(;ARD, OREGON FEE AMT.: ; 113.48
PENDING FEE. PMT. Cl
CITY HALL RLC EIPT O.: —94-z.S ' 1 4
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PENDING SECURITY ❑ PURL IC WORKS DEPARTMENT BY - - DATE -�_
I` PENDING AGENCY "O K' ❑ 1PI:'iLation and ProRTess Record
MAINTENANCE BOND +t�.
PENDING INFORMATION ❑ FOR STREET IMPROVEMENT/EXCAV,'JION ASREQUIRED
ANNUAL
PENDING VARIANCE ❑ EXPPIIt�ATIONNDDATF_:
PERMITNO.: DATE ISSUED: __!, '-_.-L_L-Lly- BY: _�1..'�Z_I�'_• ^��
-------
(1) APPLICATION IS HEREBY MADE TO j&HC[)1.AF)_DEFE�'I,M__
i (_X)NCR�TE SIDIALK __ AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CITY REQUIREMENTS.
APPLICANT (11riC Peterson) The Rock {Duality Masc Ary 615 SE Main St. Portland OR 97214, 735-0566
NAME ADDRESS CITU PHONE
CONTRACTOR (Sam)
NAME ADORE lS------ -- � —CITY
PLANS BY 1'er City Standards/Spec:if ication:i - - --- --
NAME ADDRESS CITY PHONE
ESTIMATED IMPROVEMENT TOTAL VALUATION ( COST): $ __ 462.00
DOLLARS
FOR OFFICE --'. CMIN.
(2) EXCAVATION DATA: 0.04 AS 4W.W _ s 18.48
STREET DESCRIPTION PROGRESS & INSPECTION STATUS '
NAME SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMARKS/TYPE BY
_ TYPE LENGTH WIDTH DEPTH ITEM Q QUANTITY
STREET
P N D
North Deka a St. CalcCete 5 R srPON -
E --- —
Q
U —
E j
ESTIMATED STREET OPENING DATE:1 T— —
ESTIMATED STREET CLOSING DATE: ED
STREET
(3) SECURITY NO. SECURITYAMT.: S4b2'90 — CLOSED
SURETY CO.: - FINAL
—�r - - INSPE.C.
O� CHECK CASHl
_❑ OND C'
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS:
FEATURES; EXCAVATION 1 OCATION AND EXTENT, T
iM --�;te attak_lleaei - --
1 U I 11 N
m
S.W. 1!MTH DAKCYrA ST. --- -----
INW—
SITEi 12?.80 S.W. North Aota 's't.
-r-- 1
(S) NOTE THE CITY OF TIGARD 1')OES NOT, HERflY, GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
{.I RIGHT OF WAY JURISDICTION IS THAT OF WASHINGTON ZOUNTY OR THE STATE OF OREGON.
i
THE APPLICANT AGREES TO DEPOSIT THE REQUIREL SECURITIES, TO COMPLY WITH ALL PERTINENT LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDUCT OF THE WORA, AND TO SAVE HARMLESS THE CITY AND
j EMP'_OYEES AGAINST ANY INJURY OR DAMAGE WHIrm MAY RESULT FROM APPLICANTS ACTIONS
APPLICANTS SIGNATURE' "' ' `— DATE
1y A�
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Special Conditions/Provisions:
1. All work shall conform to City of Tigard, Oregon, Standards and Specifications.
Note the attached Detail Drawings
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2. . Notify City Inspector Letha Thomas (#639-4171)24 hodrs before starting any work.
3. Access-to and egress-frorn parcels of land adjacent to the work area shall be
maintained at all times. Traffic and Pedestrian safety shall be provided for by the
contractor at all times.
4. Removal/replacement work and damage repair work shall be promptly initiated and
completed to the City's satisfaction. No work shall be considered complete until
it is accepted by the City. The City reserves the right to cause testing and
certification of work or repairs to be performed, to the City'3 Satisfaction, at
�ermittee's expense.
5. Erosion control shall be provided for by the contractor.
F
6. ORS 757.541-571 applies (pre-notification for location of underground facilities,
etc.).
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CURB JOINT -
5' MIN. SEE NOTE 5 ROW
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ROAD
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� 2' OF 3/4'-0' BASE20CK
_
1 COMPACTED SU GRADE I
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SIDEWALK ADJACENT TO CURB
• 5' MIN. ROW
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ROAD _
FISEE NOTE 5 I"
2' OF 3/4'-0' BASEROCK
1
COMPACTED SUBGRADE
SIDEWALK AWAY FROM CURB
NOTES:
1. CONCRETE SHALL BE 3000 P.S.I. AFTER 28 DAYS, 6 _,ACK MIX, SLUMP RANGE
OF 1-1/2' TO Y.
2. PANELS TO BE 5 FEET LONG. '-•.
i 3. EXPANSION JOINTS TO BE PLACED AT SIDES OF DRIVEWAY APPROACHES,
UTILITY VAULTS, WHEELCHAIR RAMPS, k AT SPACING IJOT TO EXCEED 45 FEET.
4. FOR SIDEWAIJ< ADJACENT TO THE CURB AND POURED AT THE SAME TIME AS THE
g� CURB, THE JOINT BETWEETI THEM SHALL BE A TROWELED JOINT WITH A MIN. 1/2' RADIUS E
!! 5. S30EWALK SHALL HAVE A MINIMUM THICKNESS OF 6 INCHES IF MOUNIABLE I
CURB IS USED OR IF SIDEWALK IS INTENDED AS PORTION OF DRIVEWAY.
OTHERWISE SIDEWALK SHALL HAVE: A MINIMUM THICKNESS OF 4 INCHES.
6. DRAJN BLOCKOUTS IN CURBS SHALL BE EXTENDED TO BACK OF SIDEWALK WITH 3' DIAMETER I
PLASTIC PIPE AT 2X SLOPE CONTRACTION JOINT TO BE PLACED OVER PIPE
CONCRETE SIDEWALK
RE UW-NCE APPROVED BY DRAIN BY
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CITY OF TIGARD � SU,� ,- DATE Dwc, FRE I
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' OREGON
H.T.S. 7-4-0 lDETAtI.S\CONC--SwAwC P
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3/4 R 6"� EDGE
5"
6 --:r DRAINAGE BLOCKOUT
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l PIPE W/COUPLING
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TRAVERSE EXPANSION JOINTS:
TO BE PROWED AT EACH POINT OF
TANGENCY.-OF THE CURB & AT OTHER
1 LOCATIONS AS REQUIRED TO LIMIT THE
SPACING TO A MAXIMUM OF 20 FT.
2. MATERIAL TO BE PRE--MOLDED NON-
EXTRUDED MATERIAL WITH A MINIMUM
THICKNESS OF 1/2".
TRAVERSE CONTRACTION JOINTS:
1. SPACING TO BE NOT MORE THAN 10 FT.
2 DEPTH OF THE JOINT SHALL BE AT
LEAST ONE FOURTH OF THE CROSS-
SE-CTIONAL AREA.
CONCRETE BREAKING STRENGTH:
1. TO BE 3000 P.S.I. AFTER 28 DAYS.
STANDARD CURB
SCF APPROVED BY DRAW BY
MY OR TIGARD """-'3't M CS-301 (MOD.) CAB
SCALE DATE OVrQ FILE
OREGIM N.T.S. 7-5--93 10ETAILS\aJM-SM-DWC
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TRAFFIC CONTROL
GENERAL REQUIREMENTS
1 . The City' sstandard specification for traffic control is
"Manual on Uniform Traffic Control Devices for Streets and
Highways" , U. S . Department of Transportation, F.H.A. , 1988 Ed.
2 . Traffic control shall be provided for, as illustrated, at all
time during work prosecution. No work shall be permitted(in
during the hours of darkness, nor between darkness to 8 :30
a.m. , nor 4 : 30 p.m. to darkness .
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3 . Traffic control devices, flagpecsons (etc. ) shall be D place
prior to initiation of construction work and shall, at all
times, be effectively maintained.
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4 . The roadway shall not be closed to through traffic . The
contractor shall notify emergency services (fire, police, I .
etc . ) , School District, and Tri-Met 72 hours (minimum) prior
to initiation of construction work. Advance warning of
imminent traffic disruption shall be provided to the general
motoring public by placement of an advance notification sign
at each end of the construction area 72 hours (minimum) before
initiation of construction work.
5 . The City Ins )ector shall be notified 24 hours prior to
initiation of work (# 639-4171) . f
6 . The work area shall be maintained in a clean condition, free
from obstructions and hazards . Effective erosion control
measures shall be provided for.
{ 7 . A temporary hard-surface patch shall be placed on all trenches
within the roadway at the end of each days work.
s 8 . Minimum travel-lane width shall be twelve (121 ) feet;
pedestrian travel shall also be provided for.
9 . The City reserves the right ..o restrict construction
activities during holidays and periods of high traffic levels..
The City reserves the right to add to or modify these
requirements as may be necessary to endeavor to more
effectively control traffic and to assure public safety; such
action shall not relieve the contractor of responsibility. !!
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ROAD CONSMUCTKN 0
GENERAL NOTES
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1. TRAFFIC SIGNS TO BE 48" X 48"
ONE LANE p i BLACK ON ORANGE.
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2. IJO ROAD CLOSURES,
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3. THE CITY'S STANDARD SPECIFICATION
FOR TRAFFIC CONTROL IS "MANUAL
-T- FLAGGtR I ON UNIFORM TRAFFIC CONTROL
DEVICES FOR STREETS AND HIGHWAYS",
,I U.S. DEPT. OF TRANSPORTATION, j
s e -T F,N.A., 1988 EDITION.
—°� 4. ACTUAL SIGN PLACEMENT TO BE
' ADJUSTED IN FIELD. DO NOT REDUCE
BELOW MINIMUMS WITHOUT CITY
k I p APPROVAL,
o ,Od
UPI.
5. THE CITY RESERVES THE RIGHT TO ADD TO
cuccER 04 MODIFY TRAFFIC CONTROL REQUIREMENTS
AS MAY BE NECESSARY TO EFFECTIVELY
CONTROL TRAFFIC AND TO ASSURE PUBLIC
will. SAFETY,
p rLA00M"<AD
M70-7A
e LEGEND
O CNE LME Q TRAFFIC SIGN
1`11I AMEAZ
® CONSTRUCTION ZONE
tar
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o p eONST11UCT10N TRAFFIC CONES OR j
APPROPRIATE DELINEATION
,
AHEAD DEVICE.
TRAFFIC CONTROL
TYPICAL DETAIL _
DESIGN BY APPROVED BY — OPAWl 6Y
CITY OF TIGARD _ CAB
OREGON SCALE DATE DRAIMNkl.N0,
N.T.S. 4-6-92
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C17Y OF T117A RD My =IV
COMMUNITY DEVELOPMENT DEPARTMENT offf"
13125 BW wi Blvd.P.O.Bac MW,TOW,or.pon 97 (5W)SW 176 � G E RT I F I C:A T E OF
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XXX.K ' RMIT 0. . . . . . . 9 0143 M�--009,.x.
6+,39--4171
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S I I F ADDRESS. . . 2180 13W NORTH DAKOTA ST PARC:FL a
l 00VIVtblON. . . . t 014TON PURI Z014INC;r
BLOCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . e 1
CLASS OF' WORK. aNFW
r 1 YPE ur USE. . . a ISF"
OCCUPANCY GRP. o R3
OCCUPANCY L.UAD v 1 17 4
TENANT NAME:. . . �
Remaar ka s PATH 8
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Owners
,JE'FF RCY P FISH �
FISH C ONSTRUC 1 XON CO
t834 SW 58TH AVE: #P.06
PORT1_qND OR 97?21 �
Phone #o 50:3-...�:45--56LQ
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Uontractorl _._. ._._.-..._..._.._..._,._..._..,, _.._......_....,
tf::FFRF Y P FISH
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ISH C 17.114STRUt"I ION UO
1834 EJW 59TH AVE #206 '
PORTLAND OR 972x:1 �
Phone 410 92-9891
a
Reel 41. . 62417
Ucc:m p&nc,V of the ahrcve ref•erenc eci hr.►i lclinrl is hereby Wi ven, and cert• i f i ea►
than rompllance with the �3tate Of Overlun $ilaer_ iarlty C;c►ci►as for tl►e yrR, C
ot,r.1.1panC_y, a►ncl a}e Mlder Which the rercrratived permit we % i. e,!;uecl. t
f'I RF: DEN.PnRI MF::N T _ 81.1I L I>I NI, :�IVFiI'E C TCJCi
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INSPECTION NOTICE t
City of Tigard Building ��7223
13125 Sir Ball Blvd. Tigard,
Inspection Lin^ (Rec--O-Phone): 639-4175 Business Phone: 639-417]
Inspection:�_J� —
A r Sdwlk �
Footing
plbg. Underslab Mech. Rough-in ppr/
Found. plbg. Top Out
Cas Line FINAL:
Pcct/Beam Struct. San. Sewer
"naming -Bldg.
Insulation -Plumb.
jLg
Poet/Beam Mech. Rain Drain
plbg. Underfloor water Line Gyp. Bd.
-Mech.
Time: _ AM PM
Date Roqueetedc 17
—
Permit i
Address: __�
Builder: _ - —��-- -----
Tgg FOLLOWING CORRECTIONS ARE RrQUIRED: r
✓ /� _Date:
Inspector:_-__.�+
VED APPROVED SUBJECT TO ABOVE
APPROVED DISAPPROVED v � ----
Call
For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phon 639-4175 Baoineae Phone: 639-4171
Inspection:___,
Footing Plbg, deralab Mech. Rough-in Appr/Sdwlk •
/ IFound. Plbg. Top Out Gan Line FINALS
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. R ;.n Drain Insulation -Plumb. • I
Pibg. Underfloor Water Line Gyp. Bd. -Mech.
Date Requeateds 1/ ��z �` _—Times AM —PN ft
Address:. 1 �' Permit I s ,G`l��
Builder: X-1
TNN FOLLOWING CORRECTIONS ARE REQUIRED:
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t i{ Inspectors Ir- 14 A
_L/ APPROVED DISAPPROVRD _ APPROVED SUBJRCT TO ABOVE
Call For Roinsp.
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INSPECTION NOTICE
Clty of Tigard Building Departaent
13125 SW Ball Blvd. Tigard, Or
n 97223
Inspection Line (Rec-o-phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Plbq. Undersiab !
Mech. Rough-in Appr/Sdwlk
Found.
Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer. /_
Framing llk_ -Oldg. � I
Poet/Beam Mech, Rain Drain
Insulation -Plumb.
Plbg• Underfloor Water Line
Gyp. Bd. Mech.
Date Requested,-�
Time, AM pM
Address:�2S__� L _'
`--T` Permit 1: i1L1
Builderi
1Z, THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Grl� i1
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Inspector,
— Date,
"PRO%" DISAPPROVRO
APPROVED SUBJECT TO AAOVP.
Call For Relnsp.
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INSPECTION NOTICE
City of Tigard Building Departoent
13125 SW Ball Blvd. Tigard, Oregon 97223
r Inspection Line (Rec-O--Phone): 639•-4175 Business Phone: 639-4171
4t d.i
i Inspex.tion: --
Footing PZ9. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Poet/Beam 8truct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb. ;.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: Y Time= AM PM
Address: U Permit f: -�� e
Builders
THE FOLLOWING CORRECTIONS ARE REQUIREDs
Inspector:
! Datel l/
T APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
tt+fff--- Call For Reinep.
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q INBPECTION NOTICE
* City of Tigard Building repart•mant
13125 BN Ball Blvd. Tigard, Oregon 97223 w{
Inspection Line (Ree-O-Phone): 639-4175 Business Phone: 639-4171
r Inspections
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk )
Found. Plbg. Top Out Gas Line FINALS
,e
i
Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb. til
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
t Date Requeeteds ? w� TL -"!�t-m PM
Address: �� / �- Permit #s�Z'S_5�
Builder:
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: r / / f Dates i L
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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Cit of Tigard Building pepartaeat
13125 Sw Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec--O-Phone)s 639-4175 euoineee Phones 639-4171
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Inspections
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
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Poet/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -plumb.
MAIN
Plbg. Underfloor Water Line � G�y�p.. Bd. 1 -Mech.
��
Date Requested:_ —Time= AM PM
Addreses_ 9 l -..Permit #z
Builders_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspect]'-, PPRovxr
Data:_'
DISAPPROVED APPROVED SUBJECT TO ABOVE
► Call For Rei.nep. ;��� ru in i�` �+ i j 6 ,'',� r..
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INSPECTLON NOTICE
J City of Tigard Building Departfi'int
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13126 SM Ball Blvd. Tigard, Oregon 9722
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspections
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL-
Post/Beam Struct. San. Sewer Framing -Bldg.
4 Poet/Beam Mech. Rain Drain __insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Mech.
-� PM
Date Requestedt�,E —T =
Permit Is !
Address:_���
THE FOLLOWING dJRRECTIONS ARE REQUIRED:
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Inspector:_- Date:T__--___�4_._—
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
CAll For Reinsp.
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INSPECTION NOTICR
City of Tigard Building Department J 1
13125 BA Ball Bled. Tigard, a 97223
Inspection Line (Rec-O-Phone)s 639-4175 usiness Phones 1 1
o Inspections—
` ,. Footing Plbg. derelab Hoch. Rough-in Appr/Sdwlk j
Found. Plbg. Top Out Gas Line FINALS
Poet/Beam Struct. San. Sewer Fr i 1 -Bldg. k
Post/Beam Rech. Rain Drain (" u -Plumb. l
q Plbg. Underfloor Water Line ��(,�%YP -Rech. I`
Date Requesteds `f __-_ STs --- /PN
Ad
drees:� �C/ G Pe it
Builders
THE FOLLOWING CORRECTIONS ARE REQUIRED:
It
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Inspectors__
APPROVED DISAPPROVED APPROVED SUBJE TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW SM Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-o-Phone): 639-4175 Bueineas Phone: 639-4171
Inspection: —
Footing Plbg. Underslab �Mach.�Rough-in 1 Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL: 4
Post/Beam Struct. San. Sewer �` Framing -Bldg.
Post/Beam Koch. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. [-/Koch. o
Date Requeste
d: 7 +� Time: AM _ PM
Address: �? �TG7� Permitil
Builder:
THR P.OLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date:_/ G
PPROVED DISAPPROVED -_ — APPROVED SUBJECT TO ABOVE
Call For Reinap.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SSI Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
r
Footing Plbg. Und .rslab Mech. Rough-in Appr/Sdwlk
Found. `lbg_ Top Outs Gap, Line FINAL:
Pont/Beam Struct. San. Sewer// Framing -Bldg.
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech. •
Date Requested: � _� ,Time: AM __,,*PM
Address: /,:;P/ �44
Permit #:� `C `
Builder:_
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors _ Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp. I
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INSPECTION NOTICE C/ /
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phones 639-4171
Inspections - ---
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
Post/Beam Struct. San. Sewer ) Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb. •
Plbg. Undr.rfloor Water Line ) Gyp. Bd. -Mech.
i Date Requested:— Time: AM _y�PM
Address: Permit f: —� � N
Builder
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspecllt//ors• Date:_ _--
APPROVED DISP.PPROVED _ _ APPROVED !,UBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building rePartoent
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line ic-O-Phone): 639-4175 Business Phone: 639-4171
Inspections —
Footing Plbg. Underslab Mech. Rough-i:: Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINAL:
2b,/Beam BtruckSewerFraming -Bldg.
Beam Much} Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Meeh. •
Date Requested: Z �'�7 .2— Ti — , /n^�PM
/���11 / Permit
Addreass
Builders--
TBE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inepsctolf /J' 7� Diste:_�f J /
j APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Department
13125 SW Bell Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 639-4171
Inspection: —_
Footing Plbg. Underslab Hoch. Rough-in Appr/Sdwlk
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Found. Plbg. Top Out Gas Line FINAL:
y •., Post/Beam Btruct. San. Sewer Framing -Bldg.
Y{rte,F I
„ Post/Beam Mach. Rain Drain Insulation -Plumb.
�`•
Underfloor Water Line Gyp. Bd. -Mach.
C a�„ Date P.equested: / s- f 4 , --Time rL PM
Address:1ai ?—_ Permit 1:
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Builders U,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspectors
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Inspectors Date:�^
7"PPROVED DISAPPROVED APPROVED SUBJRCT TO ABOVE
_Call For Reinsp.
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INSPECTION NOTICE
City of Tigard Building Departzieat
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Ree-O-Phone): 639-4175 Business Phone: 639-4171
Inspections ---
Footing Plbg. Underslab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS
oet/Beam 8tn�ict.) San. Sewer Framing -Bldg.
� Post/Beam Hoc hl Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Hoch.
Date Requested: — L^ _ Timm= AH — PH I
Address: / i elJ _ Permit I:J.�-
Builder: el 4/
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THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector:— ��� Dato:
APPROVED DISAPPROVED APPROVED Sr)BJECT TO ABOVE r.
{ Call For Rsinsp,.
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INSPECTION NOTICE
City of Tigard Building Departzent
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Re�c-0-�P�h/onQe)�I:,11 639-4175 Business Phone: 639-4171
Inspections —
rooting �� Plbg. Underslab Mech. Rough-in Appr/Edwlk
S
Found, Plbg. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet/Beam Mach. Rain Drain Insulation -Plumb. •
Plbg. Underfloor. Water Lino Gyp. Bd. -Nech. I
Date Requested:_ �-2 2 �_Z- _Time: fJxv AM ,�P" •
Q4
Address: Z� Permit #s_ 1
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED-
Inspector:__ ! _ +Y---.��—_ Dater
4
APPROVi:D DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
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® OL UMI~ I NG PERMIT '
CITY OF TIGARD �►@94
COMMUNITY DEVELOPMENT DEPARTMENTiee ow ~ C R rl i r #° • • • M T
13125 ow"&A P.O.Bac 23"1 TOW,crew 072 !(600)b7o 4176 c c I I F'T)• Qr E+/..}0 i r)-
' SITE ADDRESS. . . : 12180 S4 NORTH DAKOTA S" PARCEL: 17134CB--0390@ � •
SUBDIVISION. . . . : AN'FON PARK ;9N I NG i
BLOCK. . . . . . . . . . : I._OT. . . . . . . . . . . . . . 1 q
CLASS OF WORK. . :NEW GARBAUE DISPOSAL . . : 1
T YPE OF USE. . . . :taf- WASHING MACH. . . . . • . : l BACKFLOW PREVNTRS. . :i?
OCCUPANCY GRP. . :r43 FLOOR DRAINS. , . . . , . :@ TRAPS. . . . . . . . . . . . .
S•T OR I E6. . . . . . . . : 1. WATER HE:ATF RS. . . . . . : 1 CATCH BASINS. . . . . . . :0 si
LAUNDRY TRAYS. . . . . . :0 ''3F• RAIN DRAIN`;. . . . . : I I
S INK1:73 . . . . . . . , . 11 GREASE T RAPS. . . . . . . ear
LAVATORIES. . . . . 12 01HE:R 1=IXTURFG. . . . . ..0
TUN/SHOWERS. . . . : 5EWF R LINE (ft ) . . . . :0
WATER CL-USf=TS. . :2 WA I'E_R LINE~ (ft ) . . . . : 1.00
DISHWASHERS. . . . : 1 RAIN nFtA1N ( ft ) . . r,. :0 1
Remarks t PATIi 8
OWNER:
JEFFREY P FISH TIF 6 1380. 00 PLL 06/30/92
FISH CONSTRUCTION CO BPRT $ 364. 00 PL.L 06/.30/92' --
T • 0 JLH 205/20/92 22'7437
1 q.:;4 SW Fi-_,C31 AVE #.`'0c, E3Pl_C: t c?,.�6.6
PCif1TL AND Clf7 97;?21 'f"`, , B5PC 1 18. 20 F'I..L. 06/30/92 -
Phone #: 503--245-5633 aSUC '$ 280. 00 PLL 06/30/92 -
PARF; $ 300. 00 PLL 06/30/92 -
Pl q.tmbing Cent;ractor�:' _.____._.___. -___. MF-''I3T $ 36.00 PLL (AS130/'12 _
MPLC $ 9. 00 PLL 06/30/92 --
Name t I13F'C 4 1. 80 Pt._I_ 06/30/" -
Add, e�SS:_-.�pZ!�•.._c��(����} r ..._._.__ PPRT i 117. 30 PLL. @61:10/96 -
City: 9�.4YC._ ._..� .1'3tate: ',¢ _ P5PC $ .i. 88 PLL. 06f30/92 -
?_ip:
Reg lig
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REQUIRED INSPECTIONS
------This permit is issued ,ubjec-t to the r•Wg-
i.11a•tic)ns contarirred in the 'Tigard Mt(ni4ipal Foot/found Inep Rain drain Insp �
G0C1 r, State of Dr,er. Specialty Codes and all Post/Beam Struct Wafter Line Insp
other applicable laws. All work will bF, done Post/Beam Meehan Appr/Sdwlk Insp ( "
in accordance with approved plane. This Plm/-andslab Insp Mechanical F,na.l.
r-F+o�,r it will Pxpire if work i v not stinrted PL.M/Underfloor Plumb Final.
within 180 days of i.sst.tanc.:e, or if work is Mechanical Insp Building Final *;
srtspended for more than 1A0 days, Plumb Top Out Erosion Control
Framing Insp Crawl Drain
Fireplace 1nssF?
Gf a s Line Insp
Insulation Insp
6vp Board Insp
Ar.+ horizrd Plumbing Corrtractor ignatr.tre j
Call for inst.�ection - 639-4175
Contractor Not c!s:
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CITYOFTIFARD4TWI�v
COMMUNRY DEVELOPMENT DEPARTMENT one" MASTER F' . M f3 T 9 2-V_i 0'j 4
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18126 8W HW BNd.P.O.Bat 23347,Tigard,Oregon 47223(603)639.4176 (--'E R M 17 #. . . . . . :
r
639-4171 DATE ISSUED: 0E+/Ut7t/9G'
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SITE ADDREGS. . ,. : 12 180 SW NORTH DAKOTA a•r PARCEL: 1S1,74f711 121:7,70 :
SUBDIVISION. . . . : ANTON PARK 10NING:
0LOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1
------------------------------------- BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf t 4,
CLASS OF WORK. aNEW BEDRMS:3 BATHS:2 GARAGE. . . . . . . . . . :440 sf
TYPE OF USE. . . :5F FLOOR AREAS------.-.---- REQUIRED SETBACKS---•-----_--.-
TYPE OF CGNST. :5N FIRST. . . . : 1496 sf LEFT. . -90 ft RIGHT. -. 15 ft am
OCCUPANCY GRP. :R3 SECOND. . . :0 15f FRONT. :,=O ft REAR. . .-26 Ft
STORIES. . . . . . . : 1 THIRD. . . . :0 sf RE UU I RED-------______________
HEIGHT. . . . . . . . : 17 ft TOTAL--___.____...: 1496 s f: SMOKE DETECTOR'S. :Y
FLUOR LOAD. . . . :40 psf VALUE. . . . . $ : 7£7,;6 PARKING SPACES. . :0
Remarks : PAT1-i 8
PLUMBING - - _-__-_--____________________.. --___.
SINK,. „ . . . „ . . . . : 1 FLOOR DRAINS. . . , ;0 BACV%FLOW PREVNTRS. . :0
LAVATORIES. . . . . :2 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . 90
TIJH/SHOWERS. . . . -.2 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :c' SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWA%IERS. . . . : 1 WATER LINE (ft ) . : 1.00 OTHER FIXTURES. . . . . :0
GARBAGE D1SP. . . : 1 RAIN DRAIN (ft) . :O
WASHING MACH. . . 11 SF RAIN DRAINS— : 1
.-______________ MECHANICAL_ - -_ _.__ .___.._ __ -___-_._.___. _____ FEES -----__--____--. l
FUEL. TYPES------------ UNIT 11TRE1. . :0 type amount by date rec:pt �
/GAS/ / 1 VENTS . . . . . a0 TIF $ 1380. 00 PLL 06/30/922 - 1
MAX INPUT:Q BTU VENT FANS. . :3 BPRT 4 :64. 00 PLL 06/30/92 - I
FURN ( 100k . . - I HOODS. . . . . . : 1 FPLC 236. 60 JLH 05/20/92 22742,i
FURN ) =100K _-0-0 WOODSTOVES. :0 B5PC '1 18. 20 RLL. 06/30/92 -
FLOOR FURN. . . . -0 CLO DRYERS. : 1 SSDC 280. 00 PLL 06/:30/92 --
BOIL/CMP ( ^:rF-P1:0 OTHER UNITS:O PARK 500. 00 PLL 06/30/92
GAS OUTLET'S: 1 MF'RT 36. 00 PLL 061.50/92 -
t.
Owner: -_.._.._._______._...____» _._ __._________._.___ _ MPLC t 9. 00 I'LL. 06/30/92 -
JEFFREY P FISH M5GC t 1. 80 PLL_ 06/30/92 FISH CONSTRUCTION LO PPRT $ 1 1 7. �_tb PLL 06/30/92 -
1834 SW 56TH AVE #206 P5PC $ 5. x18 PLL (.',/30/92 -
PORTLAND OR 97221
Phone #: 503-245-5633
JEFFREY P FISH
FISH CONSTRUCTION CO
18:34 SW 58TH AVE: #206
PORTLAND OR 9'1221 �
Phone #: 92-9891
R +g #. . E,,'417 ---------------------------------------
$ 2'9411. 98 TOTAL.
This permit is issued subject to the regulations contained in the --- -- --- REQUIRED INSPECTIONS - -----
Tigard Municipal Code, State of Ore, Specialty Codes and all other Foot/found Insp Fireplace Ins►p
applicable laws, All work will be done in accordance with approved Post/Beam Struct Gas Line Insp
' plans. This permit will expire if work is not started 180 Fast/Beam Mecham Insulmt ion Insp
days of issuance. or if work is srispend� n^ �; er i vs. Plm/undslaib Insp Gyp Board Insp
PLM/Under floor Rain drain Insp f
V"ermitteo Mechanir_al Insp Water line Insp
Plumb Top Out Appr/Sdwlk Insp
1:s�st_ted By
I ^ amirirT Ir►sr► McGhanitaal Final ;
L Call for inspection - 639-4175
.h1li'i11r'YYIpK 'µ...Vi,
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SEWER CONNECTION
CITYOFTIFARD �r�=.�M
C*.-7
tJEKMI'1 44. . . . . . . : 5WF29c:--�tie34
COMMUNITY DEVELOPMENT DEPARTMENT ''+
131x58WwiBlvd.P.O.Besxseorr.Tlmd,OrmW9M15MIS304i75 DATE ISSUED: 06/30/92
SITE PDDRESS. . . : 12180 SW NORTH UAKoTA ST PARCEL: 1 S134CB-03900
SUBDIVISION. . . . : ANTON PARK ZONING
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . : 1
T ENAN'I NAME.. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . .
CLASS OF WORK. . . :NEW DWELLING UMTS. . : 1
TYPE OF USE. . . . . :SF NO. OF PUILDINGSe1
INSTALL TYPE. . . . :BIJSWR IMPERV SURF=ACE. . : i
Kernar^k5 : i-,ATH 8
Owner^s
-------------------------------------- ___._____________-.- FE ES
JEF=FREY P FISH type amal.rnt by date rec'pt
FISH CONSTRUCTION CO PRMT $ 1900. 00 P1_L. 06/30/92 -
1634 SP 38TH AVE #206 INSP $ :'5";. 00 PI..I_ 06/30/92 - 00
PORTLAND OR 97221
'hone #: 503-245-5633
1 ,
Contractor: -_..___._________.__.__.___-•-- ---_..._____
CONTRACTOR NOT Ohl FILE
1 -------------------------
Phnne #: 1b 1935. 00 I'OTAI_
------- REDUIRED INSPECTIONS
This Applicant Applicant agrees to cosply with all the rules and regulatiens `-r Pv)pr Irrsper-t inn
of the Unified Sewage Agency. The pereit expires 18@ days froe _
the date issued. The total aeount paid will be forfeited if the
pereit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the aeasureeent
given. the installer shall prospect 3 feet in all dioections frog
the distance given, if not so located, the installer sha rchase __•._„_.___ _____�,_..� ____ _._.____.
a ''Taa and Side Sewer” Pereit and the Agen will tai: - prai.
Permittee Siynatikre:
I s s aged By • __ _._ _..... _.-. ___ . _...•_...._._.� _..
Call for inspection 639-4175
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13125 SW Hall Blvd.
PLNC RECT k S" 3R lZ 2 z 7y3-?
CITY OF TIGARD PO[Sax 23397 PERMIT # -
COMMUNITY DEVELOPMENT DEPARTMENT Tiigard.Oregon97M
(5"3)43"171 DATE ISSUED
106 ADDRESS: l���y ��� 1`1�'� Xi�1'U TAX MAP/LOT l.sl- 3 {(.13-- 3 f uu
:UB: Avraj r/t - LOT: LAND USE:
VALUATION:
)WNE:R SPECIAL NOTES
NAME: 3q-'V�F REISSUE OF: _
\DDRLoS- f�'' � ' 3 p��'� LAST REISSUE: _
e?zC � � / FLOOD PLAIN/
?HONE: ._ �`�' `A 1� SENSITIVE LAND: _
CONTRACTOR APPROVALS REQUIRED
NAME:
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C'TihF�-'�•� ;,
c�Ny°tet ` PLANNING:
_.._.
a
ADQRE ' ENGINEERING:
_ FIRE DEPT:
PHONE" �' tr, / OTHER: 71,r
ONI'11. BOAR11 ��: /v< `// _ EXP DATE:
ITEMS REQUIRED `
UDC RlAC111:';: PLUMB: - 4x--- 7, LIST/SUBCONTRACTORS:
MECH: BUS TAX:
qCi'/FWl i':TER CALCULATIONS:
7 TRUSS DETAILS:
i
1RE5` : OTHER:
_ i
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KOPOSLD 131.1%. USE:
OMMENTS: _ � -
/�?lL��
LAII' ,1(C,NAT RE
i✓ce i ved by: ���-r _ Date Received:
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PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
3� I
Z-ud�+ 10-432 UO Building Permit Fees �' � 3� 6Y �
Y:0
10-431 00 Plumbing Permit Fees /��•'�' — /�
_ 36, - i
10-431 01 Mechanical Permit Fees k
10-230 01 State Building Tax (5%) ��S•� —
Building LY--
Plumbing t�
Mechanical
0 Plans Check Fee
104330
Building
Plumbing
Merh?nical
10-230 06 Fire --
'5,,R97-015 30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees —
25-448-04 Industrial TIF Fees
I
25-448-06 Institutional TIF Fees
i 25-448-03 Office TIF Fees -
25-448-01 Residential Traffic Fees
2.5-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) -- '- -
24-445-01 Water Quality (Fee in lieu of) _ _ --
24-445-02 Water Quantity (Fee in lieu of) ---
TOTAL
i
nm/3587P.WPF
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• C:I r( r-ir T 1 CARD - RE:C:E 1 F''1 OF VlAYME NT RECEIPT NO. c92-229014
CHECK AMOUNT a 4633. 96
NAME" a FISH CONST. CC) CASH AMOUNT 00
AL1:►RE'�!3 r 18:34 SW 58TH AVE PAYMENT OATS a 06/30/92 „
SUITE 4*206 SUS0 T 1'T 3 z(IN
PORTLAND, OR 97221--
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c'l.1RPOSE OF PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID no
BUILDING PE=RM�MST92-94 364. 017, PLUMBING PERM 1"17. `;0 �
ME:_CHAN'IC�AL PE 3A. 00 ST. BUILD PER �':_,. BB
PLAN C;HI'.C.K FE —•4. 40 SEWER USA SWR92•-184 1900. 00 �
SEWER IN:if'ECT :'5. 00 RE..SIDENTIAI_ TRAF6=IC; FEES 12:180. 00
MASS TRANSIT TIF FEE=S 100. 00 PARKS SDC t5l00. CIO
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STORM DRAIN SDC 280. 00
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1 14.180 SW NORTH DAKOTA, I_OT #1 � J
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TOTAL AMOUN'C PAID _ _) 46.13. 98 ! t
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C:I TY OF T I GARD - RFCE;I PT OF PAYMENT Rtr CE":I P•T NO. a 9 r?--2; 7437
(.:HECK AMOUNT :?50. 00
NOME FISH SH C_ONSTRUCTiON CO CASH AMOUNT a 0. 00
ADDRESS r 1834 SW 5aTH, 9LIT'TE:: 2v. PAYMENT DATE: 0 2Q) cj2
PORTLAND, OR RUBD I V I S I ON
PURPOSE OF PnYMEN T F1MJI..IN'f PA I I) PURPOSE OF PAYME N'T AMOUNT PPI D
PLAN CHECK FE 5--39R 00 _..._.._._.... _ _. _._..... _. --
-11A I (IN PARK, LOT 1
NCIRTH DAKnTO d
V0(Fat l hiOLIN'T PW I I) - ) Ep(A, OP
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