Permit CITY OF TIGARD SITE WORK PERMIT
Ck q COMMUNITY DEVELOPMENT Permit#: SIT2020-00015
TI'C ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8l3/2020
Parcel: 2S102BD02000
Jurisdiction: Tigard
Site address: 12885 SW PACIFIC HWY
Project: Astro Subdivision: NORTH TIGARDVILLE ADDITION Lot: 38
Project Description: Remove and replace existing underground petroleum storage tank. Install piping and dispensers,and new
structural tank slab.
Contractor: 4C'S ENVIRONMENTAL INC Owner: EARLYOIL LLC
1590 SE UGLOW AVE BY WSCO PETROLEUM#225
DALLAS, OR 97338 2929 NW 29TH AVE
PORTLAND, OR 97210
PHONE: 503-320-2992 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/03/2020 $1,693.95
Plan Review 08/03/2020 $1,101.07
Type of Use: COM 12%State Surcharge-Building 08/03/2020 $203.27
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 08/03/2020 $22.00
11x17)
Project Valuation: $297,000.00 Erosion Control w/Development 08/03/2020 $311.40
Site Specifics:
Excavation Volume: 950 cu.yd.
Fill Volume: 1000 cu.yd.
Impervious Surface: 2000 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: No
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking:
Fence:
Total $3,331.69I
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 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions topt�/NC by 503.232.1987 or 1.800.332.2344.
Issued By: • /� callinn _ / ) Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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 Ci/A;34/Av
Site Work RECEIVED a FUR OFFICE USE ONLYy/, J7
City of Tigard JUN 2 3 2020 alter: / lU/2.(0 < 0 PermitNo i7f).20`-'e oo'S
13125 SW Hall Blvd.,Tigard,OR 47223 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1 Date/By: l Z.0 Other Permit.
Inspection Line: 503.639.4175 GF?IGARD Due ReedyBy: furs' 0 See Paget for
"' ` l' P BUILDING DIVISION
Internet: www.tigard-or.gov Notified/FAethod: 7/3I iv Supplemental Information
c;Fey.r.l7.4_,
TYPE OF WORK 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
❑x Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El I-and 2-family dwelling Valuation: S
❑Commercial/industrial
\ El Accessory building ❑Multi-family Number of bedrooms:
\\ ❑Master builder [Other: Underground Storage Tank/ Number of bathrooms:
Disperser Replacement
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12885 SW Pacific Highway New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:WSCO Petroleum Tank Replacement Covered porch area: square feet
Cross street/directions to job site:Southwest corner of SW Walnut Street and SW Pacific Hwy Deck area: square feet
Other structure area: square feet
. `,�,,�,� REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l Lot no.:a�N Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 25102BD02000 — Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: s c ( „ 00
Existing underg
round storage tanks to be removed and replaced with new.New product piping
and dispensers to be installed.New structural tank slab to be installed. Existing building area: 386 square feet
New building area: Unchanged square feet
® PROPERTY OWNER 0 TENANT Number of stories: 1
Name:WSCO Petroleum-Mike Zirkle Type of construction: V-B
Address:2929 NW 29th Avenue Occupancy groups: M
•
City/State/ZIP: Portland,OR 97210 Existing: Unchanged
Phone: ( 503 )243-2929 Fax:( ) New: Existing to remain
® APPLICANT 0 CONTACT PERSON NOTICE
Business name: pM Design Group All contractors and subcontractors are required to be
Contact name: Amanda Martin licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 19401 40th Ave West Suite 420 jurisdiction in which work is being performed.If the
City/State/ZlP: Lynnwood,WA 98036 applicant is exempt from licensing,the following reasons
pP I y:
Phone:( 425 )405-7747 Fax: :( )
E-mail: amartin@pmdginc.com
CONTRACTOR ,,jj
Business name: TBD Lids •elrI 'ItO y11W.g.•40 BUILDING PERMIT FEES'
(masAddress: /�d St UUlas,.a Avg viewerej(ordesosit): &)
City/State/ZIP: U 1 p,,S O `i- 94.138 Structural plan review fee(or deposit): �i�(J J tl7
FLS plan review fee(if applicable):
Phone:(S03) 4,06 3640 Fax:( )
CCB lic.: /s 3a S' Total fees due upon application:
��� / Amos i 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: Mike Zirkle Date: 06/15/2020 # Fee methodology set by Tn-County Building Industry
Service Board.
L1Building\Permits1Sff-PermitApp.doc 08/02/2016 440.4613T(I I/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: 950 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 1,950 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 1,000 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
® Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 2,000 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:
Q Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting
compliance Plan
❑ Grading Plan and details ❑ *Landscaping Plan
Q 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 s.00 to$500.00 $51.09 minimum permit fee
Alterations) Submittal $500.01 to$2,000.00 $51.09 for the first$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.
S100,000.01 and over $809.42 for the first$100,000.00 and
$4.49 for each additional$1,000.00 or
fraction thereof.
1:113uilding\PermitslSrr-PermitApp.doc 08/02/2016 2
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
41
11,161/ r3
T,c A R D Building Permit Review — Commercial - No Land Use
Building Permit #: S 17 26 2 p - DO U IS
Site Address: /.2 5-sfi ) R-, i7 '2C J-i„. Suite/Bldg#:
Project Name: j j � -elmieumj ,e,y,,haAux--
(Name of commercial business occupying the space. If vacant,enlEr Spec Space.)
Planning Review��� / /�
Proposal: 1��41fe/i-,ep CP U xna! (%'Dim 7 , GL taxer-4
lr)or r �/
Existing Business Activity: 14/t/'d 41
Propos Business Activity: // // //
Yen ,site address/suite#exists and active in permit syste
II er Terrace Neighborhood: ❑ Yes No
g. 7
ermitted Use: Yes ❑ No ❑ Spec Space
Co no land use required.
Business License:
Exists: Yes ❑ No,applicant was provided a business license application
Notes:
L
Approved by Planning: Date: -?-//
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
..a
Building Permit Submittal
Original Submittal Date: 6 /2-3/20
Site Plans: # 3
Building Plans: # 3
Building Permit#: ErEnter building permit#above.
Workflow Routing: "Planning ❑ Permit Coordinator @'iii lding
Workflow Sign-off: Ig'Sign-off for Planning(include notes from planning review)
Route Application Documents: .$wilding: original permit application, site plans, building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: iffa p, 4-4--- Date: 7/1d/7-D
C\Building\Fonns\BldgPermitRvw_COM_NolandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
E Approved,NOT Released: S ate:
Notes:
Revisions (after Building Submittal only)
()\/
Revision Notice 1: Date Sent to Applican
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Applicant:
❑ SDC Fees Entered: Wash Co Trans Dev ax: ❑ Yes ❑ N/A
Tigard Trans S R ': 0 Yes ❑ N/A
Parks SDC: 0 Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordi' .tor: Date:
I:\Building\Forms\B1dgPermi tRvw_COM_NoLandUse_111819.docx