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Permit (2)
CITY OF TIGARD SITE WORK PERMIT ry COMMUNITY DEVELOPMENT Permit#: SIT2023-00017 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/21/2023 Parcel: 1 S126CD00100 Jurisdiction: Tigard Site address: 9925 SW GREENBURG RD Project: Crescent Grove Cemetery Subdivision: None Lot: None Project Description: New parking lot for(4)parking stalls and landscaping around parking lot. Contractor: DON TANKERSLEY CONSTRUCTION LTD Owner: CRESCENT GROVE CEMETERY ASSOCIATION 1628 NW EVERETT ST STE 1 9925 SW GREENBURG RD PORTLAND,OR 97209 TIGARD,OR 97223 PHONE: 503-232-0918 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 09/15/2023 $615.74 Plan Review 07/20/2023 $400.23 Type of Use: COM 12%State Surcharge-Building 09/15/2023 $73.89 Class of Work: ALT Plan Review-Fire Life Safety 09/15/2023 $246.30 Project Valuation: $63,499.00 Info Process/Archiving-Lg$2.00(over 09/15/2023 $14.00 11x17) Erosion Control w/Development 09/15/2023 $161.40 Site Specifics: Excavation Volume: 79 cu.yd. Fill Volume: 79 cu.yd. Impervious Surface: 2136 sq.ft. Engineered Fill: No Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Storn Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: No Total $1,511.56 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: Permittee Signature: Aj-t'P 7)r) rr c q,170 0 Call 5 .639.4175 by 7:00 a.m.for the next available inspection date. This permit card sha I 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 Site•Work FOR OFFICE USE ONLY Received Permit No.: n q City of Tigard R DateBy: r) .5zTo2F79`3 'ra`l • 13125SWHallBlvd.,Tigard,OR 972231 'ECEIVED Plan Renew �1Other Permit: /] ' • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ♦/ • 1"y t 2.08--oe Inspection Line: 503.639.4175 JUN 2 0 2023 Date Ready/By: ` Juris: See Page 2 for T1G;1R11 P Internet: www.tigard-or.gov Notified/Method:R„OW \A I ®Supplemental Information k in OF rIGARD �iYQ, L 110 �7. TYPE OF W REQUI DATA:1-AN 2-FAMILY DWELLING LDING DIVISION X New construction U Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all u Addition/alteration/replacement U Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ❑ 1-and 2-family dwelling X Commercial/industrial Number of bedrooms: ❑Accessory building ❑Multi-family Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 9925 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 Covered porch area: square feet Cross street/directions to job site: From HWY 217, north on SW Greenburg Rd.,on Deck area: square feet west side of road between SW Washington Square Rd. and SW Lehman St. Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: 100/500 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 1 S126CD, Tax Lots 100 and 500 equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Construct new 4-spot parking lot. Install catch basin to drain to existing storm Valuation: $ 63,499 water planter previously built to handle runoff of parking lot. Install (2) lamp posts. Existing building area: N/A square feet Install landscaping around parking lot. New building area: N/A square feet ® PROPERTY OWNER ❑ TENANT Number of stories: N/A Name: Crescent Grove Cemetery&Masoleum dba Crescent Grove Cemetery Association Type of construction: N/A Address: 9925 SW Greenburg Rd. Occupancy groups: N/A City/State/ZIP: Tigard,OR 97223 Existing: Phone:( 503 ) 639-5347 Fax:( ) New: ❑ APPLICANT ® CONTACT PERSON NOTICE Business name: Giulietti Schouten Weber Architects All contractors and subcontractors are required to he 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: y Phone:( 503 ) 975-3376 Fax: :( ) E-mail: jakew@gswarchitects.net CONTRACTOR Business name: Don Tankersley Construction LTD BUILDING PERMIT FEES* Address: 1628 NW Everett St STE 1 (Please refer to he schedule) Structural plan review fee(or deposit): City/State/ZIP: Portland, OR 97209 FLS plan review fee(if applicable): Phone:( 503 ) 232-0918 Fax:( ) Total fees due upon application: CCB lie.: 88663 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: Date: 6.27.2023 * 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) 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: 79 cu.yds. Grading Volume: (Soils report required for>5,000 cu. yds.) 79 cu.yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 90%of maximum density) 79 cu.yds. Retaining structure? (Check one) fl Rock No retaining required for project. CMU Concrete A Other: None *Total new impervious area including all buildings, sidewalks, and paving: 2,136 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: V Site Plan with Vicinity Map showing ADA r1 *Parking(including ADA) and Lighting compliance Plan A Grading Plan and details 7 *Landscaping Plan V 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 S51.09 minimum permit fee Alterations) Submittal $500.01 to$2,000.00 S51.09 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$1,000.00 or fraction thereof. 1:1Building\Permits\SIT-PermitApp.doc 08/02/2016 2 City of Tigard "1 COMMUNITY DEVELOPMENT DEPARTMENT • E ' - Building Permit Review — Commercial —Land Use/IMU zone TIGARD Building Permit #: 3'ST-70 —cX i 7 Site Address: 611 ' --S SW Gwen`boj (4 . Suite/Bldg#: Project Name: CreScu{- Grove- anittc y PavJG,n, L- (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: pow 14,-S(7o•i. 1 " ' 0'1-J1 k v'- •Q)4,3t1\11) S�rvn tk,I fly 46' 1,/101 1I lw++e po 51 5 / I ncFqu tD. J SfNp"_ 10,1/4 anJ'• to+ erify site address/suite# exists and active in permit systpl. Lle River Terrace Neighborhood: 0 Yes No [S<LandUseCase#: /bM►� � Bar�- 00©19 Ltd'Plansatch Approved Land Use: _/ _ Site Plan t Landscape Plan Er Other: C-1.;11v14 Ply (S¢P t p p .,Urban u,.....sttsjtpl g 0 Elevation Phai MM p toe_ la°j/ E-Buitcfing 1?Ieihrht: Ma.a;uu,u.a.,Ileight /Ja r yy /C fo,�;I,`aM ❑ -Prior to?emit Issuance Lr Business Lic �� —/Exists: �T Yes Sd No, applicant was provided a business license application 2f Public Facilities Improvement (PFI) Permit: �� Required: 0 Yes,applicant was notified LI No Applied For: 0 Yes ❑ No, stop intake Notes: P1co5 r^ 4?ModZ a$tro,g1. i.,J / /kMD a --o0otq, Approved by Planning: ` Date: ? /°/a -s Revisions (after Building Sub al only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: 0 Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: 7/ %f3 Site Plans: # Building Plans: # Building Permit#: I .—T'rater building permit above. Workflow Routing: fanning gineering P")se nit Coordinator [ - iIIu i ig Workflow Sign-off ff for Planning(include notes from planning review) Route Application Documents: uilding. original permit application, site plans,building$plans,engineer uteer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: � "�� Date: 2/,/y j I:1Building\Forms\BldgPemmitRvw_COM_WithLandUse_09072022.docx Engineering Review ,, Slope at building pad: _3 fl irX PFI Permit#: pR 2O2_0- 604'11 $, Conditions "Met"prior to issuance of permit Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP) ]gt,Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: 0 Yes a No Assess Water Quantity Fee in-lieu: 0 Yes 541 No T.TDA Facility on lot IX Yes 0 No Add Fee: 0 Yes X No ❑ NOT Approved by Engineering: Date Notes: Approved by Engineering: ea,.c�I i, z Date: B. 9. tz-3 Revisions(after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: ❑ Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review Conditions"Met"prior to issuance of permit ❑ Approved,NOT Released: Date: ❑ ENG Revisions Required: Date: Notes: 1 SDC Exemption 0 Applied for 0 Received /Does not apply Fees Entered: Wash Co Trans Dev Tax: ❑T Yes )1 N/A 0 Deferred Tigard Trans SDC: 0 Yes jai] N/A 0 Deferred Parks SDC: 0 Yes ilZf N/A 0 Deferred LIDA Fee: 0 Yes / N/A (Z OK to Issue/Approved by Permit Coordinator: 0Q-&_ Date: q I(e1262,5 Revisions(after Building Submittal only) Reviewer Date Revision 1: 0 Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved 1:\Building\Forms\BldgPermitRvw_COM_W ithlandU se_08162022.do cx