Permit CITY OF TIGARD SITE WORK PERMIT
I COMMUNITY DEVELOPMENT Permit#: SIT2020-00003
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2020
f Ca 4 P...D Parcel: 1 S 135B C00700
Jurisdiction: Tigard
Site address: 10795 SW CASCADE AVE
Project: Wiggle Land Subdivision: None Lot: None
Project Description: ADA parking modifications and re-striping parking stalls.
Contractor: PKNW CONSTRUCTION LLC Owner: CASCADE FUTSAL LLC
PO BOX 3686 5010 NE OREGON ST
HILLSBORO, OR 97123 PORTLAND, OR 97213
PHONE: 503-536-6427 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 02/26/2020 $123.72
Plan Review 02/12/2020 $80.42
Type of Use: COM 12%State Surcharge-Building 02/26/2020 $14.85
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 02/26/2020 $2.00
11x17)
Project Valuation: $5,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: No
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $220.99
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010through OAR 952-001-0090. ou may btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Site Work FOR OFFICE USE ONLY
Cityof Tigard R E C E I V E D Received / / .�a�_
g Date/By: .• 77aLgr) / '�- Permit No.: �1�'"/ODt?!:.
lig ' 13125 SW Hall Blvd.,Tigard,OR 972 3
4 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review _�Q
DateBy: ,-(I Other Permit:
TIGARD
Inspection Line: 503.639.4175 FEB 12 2020 Date Ready/By:// lure: ® See Page 2 for
Internet: www.tigard-or.gov N ed/Me d 'LA-C., Supplemental Iuformatiou
tCITY OF TIGARD
TYPE OF WStING DIVISION REQUIRED 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 the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: tErc
\7 law �,,,Q {�V a New dwelling area: square feet
City/State/ZIP: ‘ Garage/carport area: square feet
Suite/bldg./apt.no.: Project n � -,..)4A0111.0 ��4c., Covered porch area: square feet
Cross street/directions to job site: (�1� Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
y, DESCRIPTION OF WORK work indicated on this application. a
t�y�`�l p��.��� �, y1~ Valuation: $ �6 —�
C`^ ~�` Sv Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
APPLICANT 0 CONTACT PERSON NOTICE
Business me: CI:1)0C_ 6\CC- ._✓) 1 All contractors and subcontractors are required to be
Contact name: V �, �� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: "2 .3 Z. s E • • jurisdiction in which work is being performed.If the
City/State/ZIP: c c 441 02,_ Q\1 \q- applicant is exempt from licensing,the following reasons
apply:
Phone:(%) Q$(''aj 4'2.35^ Fax::( )
E-mail: C43,,S,Q_— 1p `•(.314q
CONTRACTOR
Business name: p‘setriv) .r7_ _ c o o, BUILDING PERMIT FEES*
Address: PO k Uy Z L/1k (Please refer re fee schedule)
7�� Structural plan review fee(or deposit):
City/State/ZIP: G/C 21/p� 7
,) ` 4 �� • J FLS plan review fee(if applicable):
(
Phone: fOKFax:( )
CCB lic.: 2ca1 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: C(I•,r\ke"G Q,(_ Date: Z\\va ?•t * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(1 l/02/COM/WEB)
City of 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: 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) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and avin : s . 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 ADA ❑ *Parking(including ADA)and Lighting
compliance 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.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation: Permit Fee:
(New,Additions or Required at $AO to$500.00 $51.09 minimum permit fee
Alterations) Submittal $500.01 to$2,000.00 $51.09 for the fast$500.00 and
$2.69 for each additional$100 or fraction
Commercial 3 thereof,to and including$2,000.00.
$2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and
Multi-Family R-1 Occupancy 3 $10.76 for each additional$1,000 or
fraction thereof,to and including
$25,000.00.
One-&Two-Family Dwelling 3 $25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and
$8.06 for each additional$1,000.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and
$5.38 for each additional$1,000.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and over $809.42 for the first$100,000.00 and
$4.49 for each additional$1,000.00 or
fraction thereof.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
City of Tigard
;I COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: , — —0-0003
Site Address: 101-9S SW Cs�cu.lk- Arc Suite/Bldg#:
Project Name: Ill, Lm�le. rcaPI,
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: PST no.,/ + .C,121-fhj frLk, 5ttr pv hiviiLou--OCO6(
gl/Verify site address/suite#exists and active in permit syst:....
Vever Terrace Neighborhood: ❑ Yes No
�d Use Case#: (1.Mc�j,i ood i
lldPla ns M,,Attli Approved Land Use:
ite Plan ❑ Landscape Plan ❑ Other:
(,,�y� ❑ Urban Forestry Plan ❑ Elevation Plan
f�L' Building Height: Maximum Height Acl Height
LN/Conditions Met: ❑ Prior to Submittal MJ Prior to Permit Issuance
I Business License: ��
Exists: 0 Yes [ No,applicant was provided a business license application
ublic Facilities Improvement(PFI)Permit: �
Required: 0 Yes,applicant was notified Ei No Applied For: ❑ Yes 0 No,stop intake
Notes: Q Q r ,
Approved by Planning: J/1P-4- �jjj,4-- Date: Z` '
Revisions (after Building Submittal only) Reviewer l)atc
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: 0714-1°
Site Plans: #
Building Plans: L-�E
Building Permit#: nter buildingpermitbove.
Workflow Routing: ng l�"Engineering smut Coordinator Ej'Building
Workflow Sign-off: Er - ff for Planning(include notes from planning review)
Route Application Documents: ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: 1/01)
I:\Building\Forms\BIdgPennitRvw_COM_W ithlandUse_l 11819.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: 0 Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: % Date: Z/!5 /Z‘/-Z‘)
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Applicant
C Fees Entered: Wash Co Trans Dev Tax: 0 Yes firN/A
Tigard Trans SDC: ❑ Yes �/A
Parks SDC: ❑ Yes C /A
OK to Issue Permit
Approved by Permit Coordinator: 41 "ate:Z1/'?J?'')
I:\Building\Forms\BldgPermitRvw_COM_Wit LandUse_111819.docx