Permit CITY OF TIGARD SITE WORK PERMIT
' 1 1� •, •"• COMMUNITY DEVELOPMENT Permit#: SIT2021-00016
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/14/2022
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco ADA Parking Upgrade Subdivision: PALMER ACRES Lot: 3
Project Description: Remove and replace striping and parking symbols for ADA area. Install new curb stops,sign posts and signs
along ADA route
Contractor: L KEELEY CONSTRUCTION CO Owner: COSTCO WHOLESALE CORPORATION
500 SOUTH EWING AVENUE STE G PROPERTY TAX DEPT 111
ST LOUIS, MO 63103 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 314-421-5933 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/13/2021 $1,595.17
Plan Review 10/06/2021 $1,036.86
Type of Use: COM 12%State Surcharge-Building 10/13/2021 $191.42
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 10/13/2021 $30.00
11x17)
Project Valuation: $275,000.00 Erosion Control w/Development 10/13/2021 $311.40
Additional Plan Review 03/10/2022 $45.00
Site Specifics:
Excavation Volume: 28 cu.yd.
Fill Volume: 16 cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: No
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $3,209.85I
Required Items and Reports(Conditions)
1 Special Inspection(see plans)
2 Ersn Cntrl 503-639-4175
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
Issued By: 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.
V VJWV VVV.V 11 , I VVV ITVVL'.1V
Building Permit Application
I
,Site Work RECEIVED FOR OFFICE USE ONI.1
City of Tigard a! Received
at d a• p` �iv Permit Nu.: 17?0.7l U�t(D'
13125 SW Hall Blvd.,Tigard,OR 97223 SEP 2 3 20Z1 Plan Review ff
Phone: 503.718.2439 Fax: 503.598.1960 Date/by: I O 7 ' j li Other Permit:
1.10.,,h n Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/6y: / '/r I See Page 2 for
Internet: www.tigard-or.gov N. -ed/Method: ♦,i '�" c.,. Supplemental Information
BUILDING DIVISION I.� ' if dA.
TYPE OF WORK REQUIRED DAT :1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed
existing Parking lot ADA Compliance Indicate the value(rounded to the nearest dollar)of all
❑ Addition/alteration/replacement ❑x Other: upgrade equipment,materials,labor,overhead,and the profi r the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ❑Commercial/industrial Valuation: $
Number of bedrooms:
❑ Accessory building ❑Multi-family
ElMaster builder 0 Other: C-G General Commercial Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: NOT APPLICABLE
Job site address: 7850 S.W. Dartmouth Street New dwelling area square feet
CityState/ZIP: Tigard,OR 97223 y Garage.icarpo rea: square feet
Suite/bldg./apt no.: Project name: ADA Parking Upgrade— („,6- , _(J Covere rch area: square feet
Cross street/directions to job site: S.W. Pacific Highway '� D area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.:APN#1 S136CD02200 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $275,000.00
Removal of existing striping,parking symbols,sign post,curb stops and salvage of accessibility
signage.Provide new striping and parking symbols,and the installation of new curb stops,sign Existing building area: square feet
posts and newlrelorated accessible signs and addition of ADA compliant curb ramps,along the
accessible route. New building area: squ
❑X PROPERTY OWNER 0 TENANT Number of stories:
Name: Costco Wholesale Corporation Type of construction: NOT APPLICABLE
Address: 999 Lake Drive Occupancy gro
City/State/ZIP: Issaquah,WA 98027
E ' g:
Phone:(425 ) 313-8100 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: Barghausen Consulting Engineers All contractors and subcontractors are required to be
Contact name: Megan Palmer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 18215 72nd Avenue S. jurisdiction in which work is being performed.If the
City/State/ZIP: Kent,WA 98032 applicant is exempt from licensing,the following reasons
apply:
Phone:( 425 ) 251 -6222 Fax: :(425 ) 251 -8782
E-mail: mpalmer@barghausen.com
CONTRACTOR... ..
Business name:- -'" L kCe,• LS - zAn t L.). BUILDING PERMIT FEES*
(Please refer to fee schedule)
�6 5rfn ,50��,v-i r a.u):f`lJ` ii. i . '` Structural plan review fee(or deposit):
City/State/ZIP: t 47h f^S � 6-3 i 03 •
, Fax: ) FLS plan review fee(if applicable):
Phone:
( 1 t ) p/�I c1?3 (
CCB lie.: g� 7Total fees due upon application:
Amount received:
Authorized signature.' �'/� aiiika. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Megan Palmi{i Date:09/21/2021 * Fee methodology set by Tri-County Building Industry
Service Board.
L1Building\Penn its\SIT-PermitApp.doc 08/02/2016 440-4613T(I 1/02/COM/WEB) I
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: 28 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 28 cu. yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90% of maximum density) 16 cu.yds.
Retaining structure? (Check one) ❑ Rock
NOT APPLICABLE ❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 11,920 sq. ft.
Site Utilities Plumbing Work: N/A
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: N/A
❑ 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 s.00 to$500-00 $51.09 minimum permit tee
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 S25,000.00 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.
l9Building\Permits\SIT-PermitApp.doc 08/02/2016 2
Site Work Permit Application
Plan Submittal Requirements
TIGARD Commercial, Multi-Family and One- & Two-Family Dwellings
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi-family R-1
occupancies. A site work permit is required for excavation, fill,grading, paving, retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
N/A Note: A separate "plumbing"permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑x map & tax lot# ❑x project name ❑x site address ❑ suite number
x❑ zoning ❑x applicant name x❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability,leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
N/A D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing:
1) Silt fence locations.
2) Bio-filter bags/other approved barrier material surrounding catch basins.
I:\Building\Permits\S1T-PermitApp.doc 08/02/2016 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
N/A F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
N/A A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805).
N/A B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
I:1BuildingPennits'S1T-PermitApp.doc 08/02/2016 4
City of Tigard
1P •
li
I COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: 5 Z 7-0z k—( OVo
Site Address: -3 gSI StiJ VARTIVIOU 1r Si . Suite/Bldg#:
Project Name: C,( '(,p
(Name of commercial business occupying the space. if vacant,enter Spec Space.)
Nil_=: S' pry„
Planning Review /� pArttsr, cK� ,
Proposal: SITS w�K for. AV Q .tn� U9bgA°5
I/ erify site address/suite# exists and active in permit sysstte
IV River Terrace Neighborhood: ❑ Yes Ld No
❑/ nd Use Case#: min -lop-obo2Y
Plan atch Approved Land Use:
Site Plan E Landscape Plan ❑ Other:
❑ Urban Forestry Plan 0 Elevation Plan
r. wilding Height: Maximum Height Actual Height
I it C.. ditions Met: 0 Prior to Submittal 0 Prior to Permit Issuance
ki► Business License:
xists: 0 Yes ❑ No, applicant was provided a business license application
Public Facilitie mprovement(PFI) Permit:
Required: Yes,applicant was notified 0 No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: mit Date: 9/V/i
Revisions (after Buil g Submittal onl , Reviewer Date
Revision 1: Approved ❑ Not Approved lat— 3/2/??
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: t`2 3, &
Site Plans: #
Building Plans: # 3
Building Permit#: R'Enter building permit#above. /
Workflow Routing: Er Planning Engineering L/ Permit Coordinator (%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 details,if applicable, etc.
Notes:
By Permit Technician: Nv`1 Date: 1 t iZ..L
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_111819.docx
Engineering Review
IrJ Slope at building pad: 2/D
❑ PFI Permit#: ///o4
El Conditions "Met"prior to issuance of building permit
,,,�//
L,�fd,' Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
rb4Vater Quality/Quantity Facility: A f/n
Assess Water Quality Fee in-lieu: ❑ Yes [No !
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes ft'YNo
E NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date: fd/4/2/
to Revisions (after Building Submittal only) Reviewer Date
Revision 1: L7 Approved ❑ Not Approved tQj f% /I 5/r/tn.L
Revision 2: ❑ Approved ❑ Not Approved
tRevision 3: 0 Approved 0 Not Approved
ZPermit Coordinator Review .
10-Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Z
Revisions (after Building Submittal only)
`�� Revision Notice 1: Date Sent to Applicant: Ps\-- 31 120 2,-2—
Revision Notice 2: Date Sent to Applicant:
p Revision Notice 3: Date Sent to Applicant:
2/SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 7 N/A
CS Tigard Trans SDC: 0 Yes 7 N/A
Parks SDC: ❑ Yes ,4 N/A
.Er OK to Issue Permit
Approved by Permit Coordinator: P14-- Date: WQILI(2021
l:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_l 1 1819.docx
Dan Santos
From: Nikki Tuason <nikkit@tigard-or.gov>
Sent: Thursday, September 16, 2021 12:42 PM
To: Megan Palmer; Dan Santos
Subject: M M D2021-00028
Attachments: MMD2021-00028 Decision.pdf
Hi Megan and Dan,
Attached is the approved decision for the land use permit application MMD2021-00028.
Moving forward,you'll need to submit a Site Work Permit for the proposed grading/striping/curbing/ADA work. Here is
the Site Work Permit application form: https://secure-
web.cisco.com/lggrk0yg B1NTs9q ATr9Cyvl8PPdxVrD UEiuHdnLv54KSGscSg7DYp4p9rCz95Hbn5pVrNGMCWfKoTcvtUP
cTAeaDhwb6QhsOALPdt82sA7kB0EKHGntdOsV1O5jL0IxZHdAr0hUPJM7QUDRQwiZp6DE4FEMHsz02F8bciCQLnhEHtduO
WsxPRBEp3WfgYIxQCHJ6JkollGkWgpUCHGGpKjhBrfnxczzsnPYdtT1Uy77B YVZhOF 1Y09m52WaiAct7pUgTN25Dn3cq-
hNgFVPdPboOuQWhEEdzS6stWexeOSzvyB4Q15ia0gYw4iwHDKmqhygZoDw3bPARPfrIXvWLjEUz3103rHx 6vVawzGJOprs
wcPP8o5hR5k9En8E/https%3A%2F%2Fwww.tigard-or.gov%2Fdocument center%2FBuilding%2FSIT PermitApp.pdf
Along with the application form, please submit the following
• Completed and signed permit applications.
• (3) copies of construction plans
• (2) copies of engineering calculations.
Please reach out to the Building Department if you have any follow up questions concerning the documents needed for
the Site Work permit.They can be reached at tigardbuildingpermits@tigard-or.gov or 503-718-2439
We are accepting physical building permit submissions only,when you're ready to submit, please drop off or mail the
permit application to our office at 13125 SW Hall Blvd.Tigard, OR 97223.
Lastly, any work performed within the Right-Of-Way will need a PFI permit.The PFI permit form can be downloaded
here. Please send the PFI permit and all related documents directly to this email: rowpermits@tigard-or.gov
Thank you!
Nikki
Nikki Tuason
Assistant Planner
City of Tigard Planning Division Community Development
13125 SW Hall Blvd. Tigard, OR 97223
Phone: (503) 718-2450
E-mail: nikkit@tigard-or.gov
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
1