Permit CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2022-00017
Date Issued: 10/13/2022
T f G, R T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 109AC 02500
Jurisdiction: Tigard
Site address: 13001 SW BULL MOUNTAIN RD
Project: City of Tigard Subdivision: 2000-086 PARTITION PLAT Lot: 2
Project Description: Site work for a new 1,120 sq.ft.wellhouse building.
Contractor: EMERY&SONS CONSTRUCTION GROUP LLC Owner: TIGARD, CITY OF
PO BOX 13069 13125 SW HALL BLVD
SALEM, OR 97309 TIGARD, OR 97223
PHONE: 503-588-7576 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 09/07/2022 $14,279.42
Plan Review 08/01/2022 $9,281.62
Type of Use: COM 12%State Surcharge-Building 09/07/2022 $1,713.53
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 09/07/2022 $38.00
Project Valuation: 11x17)
$3,100,000.00 Info Process/Archiving-Sm$0.50(up to 09/07/2022 $25.50
11x17)
Erosion Control w/Development 09/07/2022 $2,411.40
Site Specifics:
Excavation Volume: 24 cu. yd.
Fill Volume: 156 cu. yd.
Impervious Surface: 25015 sq. ft.
Engineered Fill: Yes Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: No
Fence: No
Total $27,749.47
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
Issued By: �/i� /-a/k Ji) /S Permittee Signature: �jiki) '�
Calll55003.639.4175 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
s Site Work F,OR OFFICE USE ONLY
X.
City of Tigard Receivedy 7/1z/r1- li-
Permit No.: ISMa_�17
• 13125 SW Hall Blvd.,Tigard,OR 97223AECEIVED planRevie ^Phe: 503.718.2439 Fax: 503.598.19 0 y. w74a.:S'1'� Other Permit tett �l Oo13P.
Da[eB VL/_ VV W I
c 1,1 Inspection Line: 503.639.4175 Date Ready/By: hills: H See age 2 or
Internet: www.tigard-or.gov JUL 26 2022 died/Method: U "o I Supplemental Information
TYPE OF WO REQUIRED DATA: 1-AND 2-FAMILY DWELLING
niMr:1 nIVIVON
xNew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
El 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 WCommercialiindustrial Valuation: $
❑Accessory building ID Multi-familyNumber of bedrooms:
['Master builder CI Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13001 SW Bull Mountain Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 U Garage/carport area: square feet
at 1
Suite/bldg./apt.no,: Project name:.OsR 3 R 2 s 'Jr'vr.A.��_etn..,!etucrts Covered porch area: square feet
Cross street/directions to job site:Entrance near the corner of Foran Terrace and SW Bull Deck area: square feet
Mountain Rd-property is Elizabeth Price Park Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: N/A I Lot no.:2500 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S109AC 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.
Construction of a new wellhouse buildingon previouslydrilled aquifer storage and Valuation: $�}00�04fl0
l 9 g ,-y Oco. a
recovery(ASR)well.Building site is adjacent to existing buried water reservoir. Existing building area: 0 square feet
5 i k W'_','K CU:Vt r,�c 4t�) New building area: 1,120 square feet
rgPROPERTY OWNER ER ❑ ^ ' ""t"" =l� 5`
.1 Number of stories: 1
Name:City of Tigard-Shasta Billings-Beck Type of construction:IA
Address:13125 SW Hall Blvd Occupancy groups:U
City/State/ZIP:Tigard,OR 97223
Existing:NONE
Phone:(503 )718-2698 Fax:( ) New:U
Jr APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:City of Tigard All contractors and subcontractors are required to be
Contact name:Shasta Billings-Beck 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 )718-2698 Fax: :( )
E-mail' shastabatigard-or.gov
CONTRACTOR
Business name:-Na4. fiketermined ram \ --a7�i-U AA�L.�l z BUILDING PERMIT FEES*
Address: 6"11 "Fitc-V\f� , r61 iC �- `. �r I...�(, (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP: �(1'N (`ga
Phone:( ) - ` Fax:( ) FLS plan review fee(if applicable):
5 Total fees due upon application: XI (091
CCB lic.: p,1 ` I,
r+ s Amount received:
Authorized signature:
i��ems' ?, _ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Shasta Billings-Beck Date:7/13/2022 * Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\SIT-PermitApp.doe 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: 24 cu.yds.
Grading Volume: Net: +132
(Soils report required for>5,000 cu. yds.) cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 156 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings, 25,015
sidewalks, and paving: 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:
❑ Site Plan with Vicinity Map showing ADA 0 *Parking(including ADA)and Lighting
compliance Plan
O 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 $.00 to$500.00 $51.09 minimum permit fee
Alterations) Submittal $500.01 to S2,000.00 $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.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
Eir 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 depai anent 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:1Building\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.
IABuilding\Permitsl.SIT-PermitApp.doc 08/02/2016 4
City of Tigard
■ " COMMUNITY DEVELOPMENT DEPARTMENT
IPII
T 1 G A A D Building Permit Review — Commercial - With Land Use
Building Permit #: S LT,9v?}-'UX1) 1 .7
Site Address: toot (S(J} K J40w1Pth \ Suite/Bldg#:
Project Name: 9, 4- 2 W?iUha1 1vYrfakir,rreUY f T
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review''``
Proposal: S\ W)0 fF—
'Terify site address/suite# exists and active in permit system.
❑ River Terrace Neighborhood ❑ Yes SI3lo
Land Use Case#: WW2o2-\- O0005
pPlans Match Approved Land Use:
, Site Plan ❑ Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
. um eig t Actua Height
❑ Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
❑ Business License:
Exists: es provided a business license application
111:4 blic Facilities Improvement(PFI) Permit: Yf k 262-2 ' CL)Zo'f
Required: Yes, applicant was notified ❑ No Applied For: slFrVes ❑ No,stop intake
Notes:
Approved by Planning: Date: 1 I2-(e l2iZ-
Revisions (after Building Sub tttal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 7
Site Plans: #
Building Plans: #
Building Permit#: C-. ter building
,��permitt#--above.
Workflow Routing: {i Lnning -S1-- veering ermit Coordinator B-15 i1 ding
Workflow Sign-off: �Steiy-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: - f
By Permit Technician: . ` _ '"�' �Date: /
s
I:\BuildinglForms1BldgPemiltRvw_COM_WithLandUse_I 11819.docx
Eneering Review
t Slope at building pad:
Z-PFI Permit#: 2 -ovy,pR
IQ Conditions "Met"prior to issuance of building permit
2 Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
L2"X/ater Quality/Quantity Facility: /
Assess Water Quality Fee in-lieu: ❑ Yes L��/ '
Assess Water Quantity Fee in-lieu: ❑ Yes L_J )
LIDA Facility on lot: ❑ Yes Ls No Add Fee: ❑ Yes 0 No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: fi S1-ke ., Date: 63
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit 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:
SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes ' N/A
Tigard Trans SDC: 0 Yes N/A
Parks SDC: 0 Yes 7 N/A
LIDA Fee: ❑ Yes 7 N/A
OK to Issue Permit 1
Approved by Permit Coordinator: J Date: g(g 12oZZ
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_111819.docx
Karen Abdill
From: Angela Whitney
Sent: Wednesday, August 31, 2022 1:11 PM
To: Laura Barrie
Cc: Karen Abdill; Shasta Billings-Beck
Subject: RE:Journal Entry for PFI
Attachments: JE 441.pdf
Hi all,
Here's the journal entry.
Karen—this is processed like a normal permit payment but select journal entry as the payment method and attach a
copy to the receipt.
Have a great day everyone!
Angela Whitney
Accountant
City of Tigard
503-718-2485
From: Laura Barrie<LauraB@tigard-or.gov>
Sent:Tuesday, August 30, 2022 4:20 PM
To: Angela Whitney<Angelaw@tigard-or.gov>
Cc: Karen Abdill <karen.abdill@tigard-or.gov>; Shasta Billings-Beck<shastab@tigard-or.gov>
Subject:Journal Entry for PFI
Angela-
Attached is a Journal Entry for CIP 96053 Aquifer Storage and Recovery Well #2 and Well #3.
Thank you so much!
Karen-
TIGARD
Let me know if there's anything I can do to make these easier on you.
Thank you too!
Laura Barrie I Management Analyst
City of Tigard I Public Works Dept.
Direct: 503.718.2465
13125 SW Hall Boulevard, Tigard, OR 97223 I www.tigard-or.gov
l am working remotely until further notice. I can be reached via email and cell phone 971.727.6761
I
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."
2