Permit CITY OF TIGARD SITE WORK PERMIT
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3 COMMUNITY DEVELOPMENT Permit#: SIT2021-00019
Date Issued: 6/8/2022
T GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134DC03001
Jurisdiction: Tigard
Site address: 11130 SW TIGARD ST
Project: Dirksen Nature Park Subdivision: CHERRY HILL ACRE TRACTS Lot: 6
Project Description: 28 stall off-street parking lot. Installation of erosion control measures,site grading,concrete cubs,sidewalk,
pathways solar lighting,striping and landscape.
Contractor: LEE CONTRACTORS LLC Owner: TIGARD, CITY OF
PO BOX 896 13125 SW HALL BLVD
BATTLEGROUND,WA 98604 TIGARD, OR 97223
PHONE: 360-852-2317 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 06/08/2022 $1,617.62
Plan Review 11/08/2021 $1,051.45
Type of Use: COM 12%State Surcharge-Building 06/08/2022 $194.11
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 06/08/2022 $84.00
11x17)
Project Valuation: $280,000.00 Erosion Control w/Development 06/08/2022 $311.40
Site Specifics:
Excavation Volume: 620 cu.yd.
Fill Volume: 1065 cu.yd.
Impervious Surface: 24080 sq.ft.
Engineered Fill: Yes Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: Yes
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $3,258.58
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: g7r—P7r7frt
ir4efr
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 Z_ c PZ7/2.
Site Work RECEIVED FOR OFFICE USE ONLY
�/ (J City of Tigard Received /^f Sr �, /' lO /Date/By:y: « 2421 Permit No.: � !
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Is 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 2 7 2021 Plan Revie ..01
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: a, Other Permit:
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: uris. ® Page See 2 for
Internet: www.tigard-or.gov BUILDING DIVISION fied/Method: "Tier Supplemental Information
TYPE OF WORK RE ED 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
0 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 0 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 111130 SW Tigard Street New dwelling area: square feet
City/State/ZIP: Tigard,OR. 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Dirksen Nature Park Covered porch area: square feet
f Cross street/directions to job site: SW Cornell Place. Deck area: square feet
From permit center to Burnham St to Main St to Tigard St across Fanno Crk. Other structure area: square feet
bridge crossing. Site in on the left or south side of road between bridge and Gallo Ave. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Cherry Hill Acre Tracts Lot no.: 6 Permit fees*are based on the value of the work performed.
Tax map/parcel n0.: tS134DC 3000,3001,3002,3100,3101,3102,3300,3400 Indicate the value(rounded to the nearest dollar)of all
S1341)1)0900.uro,2400,2500 29103.5 3 aroo&2S1 5B 0200. equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Construct a 28 stall off-street parking lot. Installation of erosion control measures, Valuation: $ 280,000
and site grading. Installation of concrete curb,sidewaks,and pathways. Existing building area: square feet
Installation of solar lighting,signage,striping,and landscaping. New building area: square feet
® PROPERTY OWNER 0 TENA°..i Number of stories:
Name: City of Tigard Type of construction: Park Infrastructure
Address: 13125 SW Hall Blvd Occupancy groups:
City/State/ZIP: Tigard,OR 97223 _ Existing:
Phone:( 503 ) 639-4171 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: City of Tigard All contractors and subcontractors are required to be
Contact name: Jeff Peck licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13125 SW Hall Blvd jurisdiction in which work is being performed.If the
City/State/ZIP: Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503 )718-2466 or 971-295-6588 Fax::( )
E-mail: jeffp@tigard-or.gov
CONTRACTOR
Business name: L. BUILDING PERMIT FEES*
zr_ �"��r�7?�S�
Address: � !b CL 72k, i (Please refer to fee schedule)
'� Structural plan review fee(or deposit): /d5/I6'
City/State/ZIP: Yva OrZ mix O, _ �'0 -OW
(�i FLS plan review fee(if applicable):
Phone:( ) Fax:( )
CCB lic.:
"7C.S-3 S L(// / 2- Total fees due upon application:
Amount received:
Authorized signature: -0 si .(s -,.1.- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Jeff Peck Date: 9/27/21 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(11/02/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: 620 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 200 cu.yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 1,065 cu.yds.
Retaining structure? (Check one) E Rock
❑ CMU along edge of Fanno Crk
❑ Concrete Trail near Tiedeman Ped bridge
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and p_aving: 24,080 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:
E Site Plan with Vicinity Map showing ADA 0 *Parking(including ADA)and Lighting
compliance Plan
O Grading Plan and details E *Landscaping Plan
E Erosion Control Plan and details ❑ Soils Report(if required)
EJ 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 $.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.
$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
IIIIIN Site Work Permit Application
Plan Submittal Requirements
T I G A R D 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.
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. ❑ map & tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ 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.
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\SIT-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.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
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).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 4
City of Tigard
71 4 COMMUNITY DEVELOPMENT DEPARTMENT
C
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: 6/T,202/-0o0/9
Site Address: / // g a t2' 7le3 CT Suite/Bldg#:
Project Name: P/RfSdnJ iv if iUtee iA-42(< 10rovc)tLe..44 v--(4.
(Name of commercial business occupying the space. If vacant,enter Spec Space)
Planning Review ,( —/-
Proposal: Z S S f,\. �1 57tft 7 lvt Pi (s �i✓`/iA4c e s/ ,,,,.....A-,:,(
,/?1 r il4,,,, E / / V 1rify site address/suite# exists and ative in permit system.
fiver Terrace Neighborhood: ❑ Yes (No
. 2 Land Use Case#: Cu p zo/ - _ OO J
-"Plans Match Approved Land Use:
--ET-Site Plan ❑ Landscape Plan ❑ Other:
El Urban Forestry Plan ❑ Elevation Plan
/1.1 '"Building Height: Maximum Height Actual Height
42-Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
EI tsusiness License:
Exists: „J;1--S'es El No,applicant was provided a business license application
blic Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: es ❑ No,stop intake
Notes:
Approved by Planning: (3 Date: l a -. t,. ..(
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: 9/27/021
Site Plans: #
Building Plans: # `3
Building Permit#: ['Enter building permit#above.
Workflow Routing: [Planning ([Engineering 0'Permit Coordinator ErBuilding
Workflow Sign-off: C0'Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑v'Building: original permit application, site plans,building plans,engineer and
beam calculations and trus :etails,if applicable,etc.
Notes:
By Permit Technician: i= ,,-, Date: ,/Q J�,Zo.
1:\Building\Fonns\BldgPem itRvw_COM_WithLandUse_i 11819.docx
Engineering Review
Slope at building pad: 1/ANitf
Q'PFI Permit#: Ie-
G'Conditions "Met"prior to issuance of building permit h O.
[ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP) (o..
g Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes [ ' No
Assess Water Quantity Fee in-lieu: ❑ Yes C3.No
LIDA Facility on lot: ❑ Yes C''l No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: 7r' - " Date: ttifi,Z4024
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Permit Coordinator Review
Conditions "Met"prior to issuance of building permit
Approved,NOT Released: Nis ' , Ctfryi PR— Date: \Of k� (2a'i
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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
OK to Issue Permit
Approved by Permit Coordinator: Arra Date: (p\i )1,022-
1:\Building\Forms\BidgPermitRv w_COM_W ithLandUse_1118 1 9.docx