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Permit (3)
CITY OF TIGARD SITE WORK PERMIT '�. COMMUNITY DEVELOPMENT Permit#: SIT2022 00012 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/26/2022 Parcel: 1S126CC00200 Jurisdiction: Tigard Site address: 10069 SW CASCADE AVE Project: Tesla Subdivision: None Lot: None Project Description: Site work for new 4,757 sq.ft.shell building. Contractor: MESA CONTRACTING Owner: 10065 SWC LLC 20152 SW ROY ROGERS ROAD BY ALSTON&BIRD LLP UNIT 215 BANK OF AMERICA PLAZA SHERWOOD, OR 97140 101 SOUTH TRYON ST STE 4000 CHARLOTTE, NC 28280 PHONE: 971-224-4848 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 09/23/2022 $3,606.69 Plan Review 09/23/2022 $2,344.35 Type of Use: COM 12%State Surcharge-Building 09/23/2022 $432.80 Class of Work: NEW Info Process/Archiving-Lg$2.00(over 09/23/2022 $52.00 11x17) Project Valuation: $722,834.95 Erosion Control w/Development 09/23/2022 $686.40 Site Specifics: Excavation Volume: 20 cu.yd. Fill Volume: 75 cu.yd. Impervious Surface: 0 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: No Total $7,122.24 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fol�w the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You y ;btain a copy of the rules Issued By: 4v`✓1 7 Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. r 0 1i Building Permit Application ' a ` a Site Work 1 , FOR OFFICE USE()NUN City of Tigard Received -.. Date/By: Permit No.: .T .1 " J,lllgi ,, _4 � 13125 SW Hall Blvd.,Tigard,OR 97223 1Jt` (t` .� Phone: 503.718.2439 Fax: 503.598.1960 Bn ul 1 Date/By:Plan Review 6.a$_ �/ Other Permit: '�Dl�,�D_ T I G A K D Inspection Line: 503.639.4175 � Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: el J,/I.�'". /�," I Supplemental Information TYPE OF WOR M1 ,REQIJIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ®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: $ ❑Accessory building El Multi-familyNumber of bedrooms: El Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 10069 SW Cascade Avenue New dwelling area: square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Tesla Covered porch area: square feet Cross street/directions to job site: Route 217 to 210.Turn left on to SW Cascade and 210. Deck 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.: 1 S 126CC00200 equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Nev., Go l c,., ri< ;G,e i l -Fr r- +-est, Sl nwtbot0. Valuation: $ 722,834.95 /465-0 + Existing building area: 41,I OS square feet c.`a,,fet( S woS"K ava4- -fi N . See- P4 ,e, Z cco- g i..ke.4.,--4-:eg, New building area: y, I S.y square feet NI PROPERTY OWNER 0 TENANT Number of stories: I Name: 10065 SW LLC Type of construction: (,i _.., P Address: 570 Delaware Ave Occupancy groups: f3 City/State/ZIP: Buffalo,NY 14202 Existing: Phone:( 716 ) 878-9432 Fax( ) (716)880-3529 New: ❑ APPLICANT E CONTACT PERSON NOTICE Business name: Permit Advisors LLC All contractors and subcontractors are required to be Contact name: Alex Raymond licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 3001 Bishop Drive#300 jurisdiction in which work is being performed.If the City/State/ZIP: San Ramon CA 94583 applicant is exempt from licensing,the following reasons apply: Phone:( ) 925 858-1785 Fax::( ) E-mail: alex@permitadvisors.com ' CONTRACTORS � ��1d:' Business name: f' Q...Sci O Z jZL. ' 1,11 N' ' ,; Address: .A0 5a_� 'a,R -G� R� �1 r. il�. , City/State/ZIP: '- .('L,�ft c 7/Id ` ' Structural plan review fee(or deposit): Phone: 9 Li$'l-i V Fes:( ) FLS plan review fee(if applicable): U I {1, CCB lic.: ! r Total fees due upon application: I to l t) �) Amount received: Authorized signature: This permit application expires if a permit is not obtained + within 180 days after it has been accepted as complete. Print name: A te,,4 pft,efM e N r, Date: V / /01.2 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB) r .,gf f 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: 20 cu.yds. Grading Volume: (Soils report required for>5,000 cu.yds.) 95 cu.yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 90%of maximum density) 75 cu.yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑X Concrete El Other: *Total new impervious area including all buildings, -2,252 SF (project has a reduction in sidewalks,and paving: impervious area) 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: ❑X Site Plan with Vicinity Map showing ADA ❑X *Parking(including ADA)and Lighting compliance Plan ❑X Grading Plan and details ❑X *Landscaping Plan ❑X 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$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 $10.76 for each additional$1,000 or Multi-Family R-1 Occupancy 3 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 `°� ��" � g _ EGE V J� INCOMMUNITY DEVELOPMENT DEPARTMENT g r, TIGARD Building Permit Review — Commercial - With Land Use Building Permit #: S-T-1 aoaa--Coc)1 Site Address: CCICsict SW Csca Ave Suite/Bldg#: Project Name: Tcsia (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: 5I+C WO6L- gr Verify site address/suite#exists and active in permit system. 0 River Terrace Neighborhood: ❑ Yes ,C(No X Land Use Case#: 0.1A 2,{- 4 S Plans Match Approved Land Use: Site Plan ,'Landscape Plan ❑ Other: Urban Forestry Plan Elevation Plan tr% :uilding Height: Maximum Height tual Height 0 Conditions Met: 7rPrior to Submittal l Prior to Permit Issuance Business License: Exists: Yes ❑ No,applicant was provided a business license application Public Facilities Improvement(PFI)Permit: pFi7022 —75 Required: der Yes,applicant was notified ElNo �,�,,�,nApplied For: Yes El No, stop intake Notes: � COA-S *U Z FR 202 -Uao 3 is ..r Y'b'` 2 Approved by Planning: n?.°°.e -' Date: 0 1 t[2_0 2 2 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: 6.//3/4 r Site Plans: # 3 Building Plans: # Building Permit#: IN- Enter building permit#above. Workflow Routing: Et Planning Cg Engineering © Permit Coordinator IN Building Workflow Sign-off: Ea Sign-off for Planning(include notes from planning review) Route Application Documents: Building original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: 44011 $ r `,i t I Date: ja VaZ I:\Building\Fonns\BldgPennitRvw COM_WithLandUse_111819.docx p - . Engineering Review E / lo Slope at building pad: 4° LEA" PFI Permit#: 2022_o'f i s ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP) Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes ['No Assess Water Quantity Fee in-lieu: ❑ Yes 'No LIDA Facility on lot: 14 Yes ❑ No Add Fee: ❑ Yes R'No ❑ NOT Approved by Engineering: Date Notes: Do no)- hf jq.J i vi h i cafi 5 c.Ye wtj+ a&/ PrZ q pprovcd Approved by Engineering: "rry. ,1-1- A e,2 k e,,. Date: 7/7/ZoZ Z Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved a Permit Coordinator Review onditions "Met"prior to issuance of building permit Zr Approved,NOT Released: Date: i11?I2 22- Notes: Mit 0.4 ??t A Cols i ix YY tk_ 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 J'N/A Parks SDC: ❑ Yes / N/A LIDA Fee: ❑ Yes ,el N/A ,Z OK to Issue Permit Approved by Permit Coordinator: lAtINie- Date: Ci 114[20 Z 2 I:\Building\Forms\BldgPermitRvw COM WithLandUse_111819.docx