Permit CITY OF TIGARD SITE WORK PERMIT
IN a COMMUNITY DEVELOPMENT Permit#: SIT2020-00018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/17/2021
T[G A R T) 9 Parcel: 1 S126CD00100
Jurisdiction: Tigard
Site address: 9985 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Site work for a new 2,776 sq.ft.administration building.
Contractor: DON TANKERSLEY CONSTRUCTION LTD Owner: CRESCENT GROVE CEMETERY ASS
1927 NW KEARNEY ST CRESCENT GROVE CEMETERY
PORTLAND, OR 97209 9925 SW GREENBURG ROAD
TIGARD, OR 97223
PHONE: 503-232-0918 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/13/2021 $1,033.92
Plan Review 11/05/2020 $672.05
Type of Use: COM 12%State Surcharge-Building 05/13/2021 $124.07
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 05/13/2021 $34.00
11x17)
Project Valuation: $150,000.00 Info Process/Archiving-Sm$0.50(up to 05/13/2021 $6.00
11x17)
Erosion Control w/Development 05/13/2021 $236.40
Site Specifics:
Excavation Volume: 375 cu.yd.
Fill Volume: 50 cu.yd.
Impervious Surface: 4391 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence:
Total $2,106.44
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
2 Special Inspection(see plans)
' 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 e 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules ar Set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503. :/1987 or 1.800.332.2344. /c
Issued By: Permittee Signature: �LP-(/t170-,J
Call 503.639.4175 by 7:00 a.m.for the next available inspection
date.
/"� """"11 VV""
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 / �� i� j
Site Work RECEIVE. q I1,lt itltlt 1 1 ,t tl.l.N
City of Tigard Received �/ 45 L020 %7 Perme No.:eI T202b'40�g
OCT 2 8 2020 may. �'(�
II 13125 SW Hell Blvd.,Tigard,OR 97223 Plan Review JO Z�
S Phone: 503.718.2439 Fax: 503.598.1960 pyugy; � '—'Tr Other Permit
In
R
Tge 2 tor
tt:nRtr Internet:r nwww.tigard-or.gov75 CITY OF TIDIVISIOARDN
rter 21am!! leee mentalInformatbe
BUILDING DIVIS.�ON
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
g New construction 0 Demolition Permit fees'are based on the value of the work performed.
0 Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicatTd on this application.
Valuation: S
0 1-and 2-family dwelling g Commecial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9945 SW Greenburg Rd. New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Crescent Grove Cemetery Admin Bldg Covered porch area: square feet
Cross street/directions to job site: From HWY 217,north on SW Greenburg Rd.,on Deck area: square feet
on west side of road between SW Washington Square Rd.and SW Lehman St. Other structure area: square feet
C'/
__ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ( Lot no.:100 and 500 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.•WCTM 15126CD,Tax Lots 100 and 500 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Construct new office administration building of 2,776 SF.Install new utilities Valuation: S 150,000
including sewer,underground electrical,waterline and meter,gas line/meter Existing building area: square feet
and stormwater facilities. New building area: 2,776 square feet
g PROPERTY OWNER 0 TENANT - Number of stories: 1
Name:Crescent Grove Cemetery&Masoleum dba Crescent Grove Cemetery Association Type of construction: VB
Address:9925 SW Greenburg Rd. Occupancy groups: B
City/State/ZIP: Tigard,OR 97223 Exis
ting: B
Phone:( 503)639-5347 Fax:( ) New: B
0 APPLICANT ® CONTACT PERSON NOTICE -
Business name: Giulietti/Schouten AIA Architects,PC All contractors and subcontractors are required to be
Contact name: Jake Weber licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2800 NW Thurman St. jurisdiction in which work is being performed.If the
City/State/ZIP: Portland,OR 97210 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503 ) 975-3376 Fax::( )
E-mail.jakew@gsarchitects.net
CONTRACTOR
Business name: Don Tankersley Construction LTD BUILDING PERMIT FEES'
Address: 1927 NW Kearney 5t. ---. Mow leer 1*fee adreQ.)li/
Structural plan review fee(or deposit): y 2,,,o,5
City/State/ZIP: Portland,OR 97209
FLS plan review fee(if applicable):
Phone:( 503)232-0918 Fax:( )
CCB Gc.: 88663 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
///e66rsley��--- � � within 180 days after It has been accepted as complete.
Print name: Don Tankersley Dale + Fee methodology set by Tn.County Building Industry
Service Board.
I:\Building\Peroits\SFT-PennitApp.doc 08/02/2016 440-4613T(I 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: 375 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 185 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be comppcted to
90%of maximum density) 50 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
® Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 4,391 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:
2 Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting
compliance Plan Not req'd.per land use decision.
® Grading Plan and details ® *Landscaping Plan
Z Erosion Control Plan and details ® Soils Report(if required)
El 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 $_oo 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.
$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.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
UPI
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: S'f rzOZC'-deo/8
Site Address: 9985 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: Site work for new administration building
ElVerify site address/suite#exists and active in permit system.
❑° River Terrace Neighborhood: ❑ Yes Q No
El Land Use Case#: ADJ2020-00013 (See MMD2020-00021 for conditions)
QPlans Match Approved Land Use:
IS Site Plan Landscape Plan then:
EV rban Forestry Plan ni, levation Plan
1 U Building Height: Maximum Height Actual Height
III Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
IJ iusiness License:
Exists: ❑ Yes ❑ No, applicant was provided a business license application
ElPublic Facilities Improvement(PFI) Permit:
Required: ElYes,applicant was notified ❑ No Applied For: ElYes ❑ No, stop intake
Notes: Do not issue until Engineering conditions have been satisfied.
Approved by Planning: ___S;r)� _ Date: 11/4/20
Revisions (after Building Submittal only) Reviewer Da lc
Revision 1: ❑ Approved 0 Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: `OA0/1o20
Site Plans: # 3
Building Plans: # 3
Building Permit#: Enter building ermit#above. �y
Workflow Routing: Planning Engineering Permit Coordinator u Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: El"-Building: original permit application,site plans,building plans, engineer and
beam calculations and trust • - ails,if applicable,etc.
Notes:
By Permit Technician: jlWil;7///0 Date: /,/OS/OZU
ClBuilding\Forms\BldgPennitRvw_COM_W ithLandUse_l 11819.docx
Engineering Review /
El Slope at building pad: 2-C/a
FI Permit#: !!!
0/Conditions "Met"prior to issuance of building permit
11 (encroachments)perengineering approvalplattypicalSDR/CUP)
Easements encroachments conditions of and (not on
Q Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 5No ry
Assess Water Quantity Fee in-lieu: ❑ Yes L7 No
LIDA Facility on lot: 12 Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date: 5
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
1rinkCoordinator Review
C. ditions "Met"prior to issuance of building permit
0 pproved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
vision Notice 3: Date Sent to Applicant:
b 4 PC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes A
Tigard Trans SDC: ❑ Yes /A
Parks SDC: ❑ Yes N/A
R, OK to Issue Permit
Approved by Permit Coordinator: "� Date: rli(/2/
I:1Building\Forms\BIdgPertnitRvw_COM_W ithLandUse_111819.docx