Permit CITY OF TIGARD
COMMUNITY DEVELOPMENT COMMERCIAL MANUFACTURED
STRUCTURE PERMIT
s
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Permit#: CMS2020-00003
T I i;A R - g Date Issued: 10/26/2020
Parcel: 1S126CD00100
Site address: 9925 SW GREENBURG RD Jurisdiction: Tigard
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Placement of a 1,440 sq.ft.manufactured building.
Contractor: PACIFIC MOBILE Owner: CRESCENT GROVE CEMETERY ASS
PO BOX 1404 CRESCENT GROVE CEMETERY
CHEHALIS,WA 98532 9925 SW GREENBURG ROAD
TIGARD, OR 97223
PHONE: 360-748-0121 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: CMS MH State Admin 10/22/2020 $30.00
Class of Work: NEW Type of Const: VB MH BLD Permit 10/22/2020 $275.50
Occupancy Group: B 12%State Surcharge-Building 10/22/2020 $33.06
Stories: 1 Height: 15 ft
Project Valuation: $0.00
Floor Areas:
First Floor Area: 1416
Second Floor Area: 0
Third Floor Area: 0
Total Area: 0
Required Setbacks:
Left: 3 Right: 3
Front: 10 Rear: 10
Required:
Parking Spaces: 1 Fire Sprinklers: No Total $338.56
Smoke Detectors: Yes Party Wall: No
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
952-001-0D10 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �U` `.9( Permittee Signature: O(\ 1` C a�o1,
l "[//J 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.
Manufactured Structure si
Placement Permit Application_ gy,�^ : ti` FOR OFFICE USE ONLY
ecetved
City of Tigard DateBy: 6d/;IA
, - Permit No.: .5�. j�ty3
IN . 0 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review -.�•��r
Phone: 503.718.2439 Fax: 503.598.1960 AUG 2i 2020 Date/By: t" '�p ' ! Other Permit: % . 00.1.14.
Inspection Line: 503.639.4175 Date Ready/ y: + ( /ttt luris�: ® See Plan Subrninal
T[G A k D , r , Notified/Methoda 7i�7C ti) , �s-„_. Requirentenrc
Internet: wvvw.ti�ard-or.gov ti.
�:'i. ',rlHt rJ�'Tk %
JOB SITE INFORMATION OWNER INFORMATION
Site Address: 9925 SW Greenburg Rd. Name: Crescent Grove Cemetery&Masoleum
dba Crescent Grove CemeterLAssociation
Park Name: Address: 9925 SW Greenburg Rd.
Subdivision&Lot#: WCTM 1 S 126CD,Tax Lots 100 and 500
Directions to inspection site: HWY 217,north on SW Greenburg Rd.,on City: Tigard State:OR ZIP: 97223
west side of road between SW Washington Square Rd.and SW Lehman St. Phone: 503-639-5347 Fax:
Is property inside city limits? 1 X Ye ❑ No E-mail: nancy@crescentgrovecemetery.com
LOCAL GOVERNMENT APPROVALS
Zoning Sanitation
Signature: Signature:
Jurisdiction: Jurisdiction:
Date: Date:
MANUFACTURED PLACEMENT PERMIT FEES
Cost(each) No.of Sum
(1) Installation/re-inspection Items
(a) Placement(includes placement,electrical feeder,30'of water/sewer connection)' $ 275.50 1 $ 275.50
(b) State surcharge at 12%(of placement fee only)' $ 33.06 1 $ 33.06
(b) Re-inspection(includes inspection and 12%state surcharge)' $ 100.80 1 S 100.80
Placement permit to be obtained only by homeowner,or Oregon-licensed manufactured dwelling installer.
(2) Electrical
Pr (a) Service and/or feeder(new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor
performing work.
(3) Plumbing
(a) ,,, ,water service(for services over 30 lineal feet)' $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain(for services over 30 lineal feet)' $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon-licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee(State of Oregon): $ 30.00 1 $ 30.00
(b) System development fees(sewer connection,storm water,parks development&traffic impact). $ See Permit&System Development Fees
SUB-TOTAL $ 439.36
SET-UP OR INSTALLATION CONTRACTOR \PPI,U',\N I
Name: Pacific Mobile Structures Inc. Name: Giulietti/Schouten AIA Architects PC
Address: 13970 Fir St. Address: 2800 NW Thurman St.
City: Oregon City I State: OR I ZIP: 97045 City: Portland State: OR I ZIP: 97210
Phone: 971-233-0222 Fax: 503-722-2988 Phone: 503-975-3376 Fax:
CCB No.: 50832 MDI No.: E-Mail: jakew@gsarchitects.net
SKIRTING CONTRACTOR
Name: Pacific Mobile Structures Inc. I hereby certify that the information above is true and correct.
All work to be performed shall be in accordance with all
Address: 13970 Fir St. governing laws and rules.
City: Oregon City State: OR ZIP: 97045 1& AA c" 'i,...-- '- 1i61 bn°
Phone: 971-233-0222 Fax: 503-722-2988 Authorized attire Date
CCB No.: 50832 MDULSI No.: Print Name: Nancy Felton
I:\Buildina\Permits\CMS-PermitApp.doc 02/27/2018
CleanWat;r4 Services
SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT
Clean Water Services File Number 1 20-002530 iY
1. Jurisdiction: Tigard
2. Property Information(example: 15234AB01400) 3. Owner Information
Tax lot ID(s): Name: Crescent Grove Cemetery Assodalion DBA Crescent Grove Cemetery&Masoleum
-1-s-4-26613 4k-- 1S126CD00100 Company:
Address: 9925 SW Greenburg Rd.
OR Site Address: 9925 SW Greenburg Rd. City,State,Zip: Portland, OR,97210
City, State,Zip: Tigard, OR, 97223 Phone/fax: 5036395347
Nearest cross street: SW Lehman St. Email: nancy@crescentgrovecemetery.com
4. Development Activity(check all that apply) 4. Applicant Information
❑ Addition to single family residence(rooms, deck,garage) Name: Jake Weber
❑ Lot line adjustment ❑ Minor land partition
Company: Giulietti/Schouten AIA Architects
❑ Residential condominium 0 Commercial condominium Address: 2800 NW Thurman St.
❑ Residential subdivision 0 Commercial subdivision City,State,Zip: Portland,OR, 97210
® Single lot commercial 0 Multi lot commercial Phone/fax: 503-975-3376
Other Email: jakew@gsarchitects.net
6. Will the project involve any off-site work? ❑Yes 0 No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
Proposing to replace existing office building with a new building in the same location, and use of temporary building.
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site
Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local,state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the in-formation contained in this document,and to the best of my
knowledge and belief,this information is true, complete, and accurate.
Print/type name Jake Weber Print/type title Principal
Signature ONLINE SUBMITTAL Date 9/17/2020
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered.This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
o THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by (�- �. ,.._ Date 9/25/2020
Once complete,email to:SPLReviewlcIeanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services,2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
fieviscd 2/2020
Main Office • 2550 SW Hillsboro Highway ° Hillsboro,Oregon 97123 • p: 503.681.3600 f:503.681.3603 • cleanwaterservices.org
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Q ° I ` ' ' - /'��p, 0 / I I� PROPERTY ID#: R236783+R2202841 U Z
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OSITE PLAN S AND USF CASE NO: ADJ-2020-00013 ? N o IL a ILMMD-2020-00021 2 N
SCALE: 1"=100'-0"
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
C
TiGARD Building Permit Review — Commercial - With Land Use
Building Permit #: ��j�j� )_ 1.-,3
Site Address: 9925 SW Greenburg Rd Suite/Bldg#:
Project Name: Crescent Grove Cemetery
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: New temporary manufactured building
❑r Verify site address/suite#exists and active in permit system.
❑ River Terrace Neighborhood: ❑ Yes El No
❑ Land Use Case#: ADJ2020-00013 (See MMD2020-00021 for conditions)
❑s Plans Match Approved Land Use:
0 S. e Plan i andscape Plan ►.• Other:
i`I rban Forestry Plan ❑r Elevation Plan
❑o Building Height: Maximum Height 45 Ac al Height 11
Ti Conditions Met: ❑ Prior to Submittal Prior to Permit Issuance
Business License:
A
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes, applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Notes:
_ /Approved by Planning: �.' ,�,,�, Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 8/�/,
Site Plans: #
Building Plans: #
Bflo Permit#: glding er ngin bog. / g
Workflow Routing: Tannin "'‘Engineering Permit Coordinator E Butldin
Workflow Sign-off: ISdi off for Planning(include notes from planning review)
Route Application Documents: uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 7
By Permit Technician: / Date: t!S f0-/2-0
1:\Building\Forms\Bl dgPermitRvw_COM_W ithLandUse_1 11819.docx
Engineering Review
E Slope at building pad:
I�� >-n r`
Permit#: ( A
L���J c��onditions "Met"prior t issuance of building permit �C(r/9
L�-Sasements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
P"TVa.rier Quality/Quantity Facility:Assess Water Quality Fee in-lieu: ElYes LA N Assess Water Quantity Fee in-lieu: ❑ Yes LS No
LIDA Facility on lot: tv,lyt-t,45 Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: W.i."_, f;S. . Date: // -4 o'L -)
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Pe, It 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: E
. SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: CI g N/A
OK to Issue Permit ` 2 ,
Approved by Permit Coordinator: �✓�� Date: /& J/J2-0
1:\Building\Fonns\B1dgPertnitRvw_COM_W ithLandUse_l 11819.docx