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Permit
CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Permit#: SIT2023-00016 T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/18/2023 Parcel: 1 S135BA00102 Jurisdiction: Tigard Site address: 10154 SW WASHINGTON SQUARE RD Project: BioLife Plasma Subdivision: OAKBURG Lot: 9 Project Description: Parking lot and sidewalk modifications. Contractor: WDS CONSTRUCTION INC Owner: PPR SQUARE TOO LLC 111 ROWELL ST BY MACERICH RET BEAVER DAM, WI 53916 PO BOX 4085 SANTA MONICA, CA 90411 PHONE: 920-356-1255 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 09/18/2023 $1,110.25 Plan Review 09/18/2023 $721.66 Type of Use: COM 12%State Surcharge-Building 09/18/2023 $133.23 Class of Work: ALT Info Process/Archiving-Lg$2.00(over 09/18/2023 $10.00 Project Valuation: $167,000.00 11x17) Site Specifics: Excavation Volume: 200 cu.yd. Fill Volume: cu.yd. Impervious Surface: 351 sq.ft. Engineered Fill: No Soil Report Required: Paving: Yes Grading: Yes Landscaping: Yes Site Prep: No Storn Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: No Total $1,975.14 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 77 Issued By: �.iL /�j�� l-/�/`�-�— 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. Building Permit Application Site Work RECEIVED FOR OFFICE USE ONLY g JUL 13 2023 Received "►�13 �22 1W ( �23. 0001(a Cl of Tigard e Pcnmt No 114 a 13125 SW Hall Blvd.,Tigard.OR 97223 Plan Review 2 C Phone: 503.718.2439 Fax: 503.598.1960 Dale/By. ' 0?3 Other Permit TI lib RQ Inspection Line: 503.639.4175 CITY OF TIGARD Uatc Ready/B � � bids 0 See Pageifor Internet: www.tigard-or.gov BUILDING DIVISION "°'°1e /Me`I'od• 3 Supplemental Information " iOniNt TYPE QF WORK REQUIRED DATA:I 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 ❑ Addition/alteration/replacement ❑x Other: i P over-ieilt equipment,materials,labor.overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: S ❑ I-and 2-family dwelling '<❑Commercial/iudusu-ial ❑Accessory building ❑ Multi-family Number of bedrooms: ❑ Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 10154 Southwest Washington Square Road New dwelling area: square feet City/State/ZIP: Portland, OR, 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: BioLife Plasma Services Covered porch area: square feet Cross street/directions to job site: The property is bounded by SW Greenburg Rd to the Deck area: square feet east and Southwest Washington Road to the south and west. Other structure area: square feet REQUIRED DATA:COMMERCIAL USE CHECKLIST, Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 1 S135BA00102 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. arking lot and sidewalk modifications,4 Valuation: S167,000 Existing building area: square feet 12,754 eani4erd-3er+hiee New building area: square feet PROPERTY OWNER ❑''. TENANT Number of stories: 1 Name: BioLife Plasma Services Type of construction: IIB- Fully Sprinklered Address: 10154 SW Washington Square Road Occupancy groups: B City/State/ZIP: Portland, OR, 97223 Existing: Vacant- M Phone:( ) Iax: ( ) New: Prnooced B ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: Excel Engineering, Inc. All contractors and subcontractors are required to be Contact name: Jason Daye licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 100 Camelot Drive jurisdiction in which work is being performed.If the City/State/ZIP: Fond du Lac. WI 54935 applicant is exempt from licensing.the following reasons apply: Phone:( 920) 926-9800 Fax: : E-mail: iason.daye@excelengineer.com -- , CONTRACTOR Business name: 14iDerCibi'rGk'uetiOR Sep, taathLei a pixiLozitoBUILDING PERMIT FEES* Address: 1.8&-�O v rtve (Please refer to fee schedule) Structural plan review fee(or deposit): City/State/ZIP: Phone:(.ga) 456 ASS. Fax:( ) FLS plan review fee(if applicable): CCB Tic.: �� Total tees due upon application: $909.42 it$300.83 Amount received: $1,110.25 Authorized signature: ems_ This permit application expires if a permit is nut obtained 07/1 1/23 within 180 days after it has been accepted as complete. Print name: Jason Daye, P.S. Date: * Fee methodology set by'Fri-County Building Industry Service Board. I:\Building\Permits\SIT-Perm itApp-doe 08/02/2016 440-4613T(I I/02/COM/WEB) Building Permit Application Site Work FOR OFFICE USE ONLY City of Tigard Reeelved Puma No Date/Bv: ` 13125 SW Hall Blvd..Tigard.OR 97223 Plan Review 6 Phone: 503.718 2439 Fax: 503598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: nark' I IZ See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental information TYPE OF WORK REQUIRED 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 ❑Addition/alteration/replacement ❑Other: Tenant lnprovetnent equipment,materials,labor,overhead,and the profit for the work indicated on this application. CATEGORY OF CONSTRUCTION ❑ Valuation: I-and 2-lantily dwelling Q Couuncrcial/industrial S ❑Accessory building D Multi-family Number of bedrooms: ❑ Master builder Number of bathrooms: . ❑ Other: JOB SrFE INFORMATION AND LOCATION i1;1 ,' Total number of floors: Job site address: 10154 Southwest Washington Square Road New dwelling area: square feet City/State/ZIP: Portland, OR, 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: BioLife Plasma Services Covered porch area: square feet Cross street/directions to job site: The property is bounded by SW Greenburg Rd to the Deck area: square feet east and Southwest Washington Road to the south and west. Other structure area: square teet "REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 151358A00102 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. Internal building renovation, parking lot and sidewalk modifications, new 2"water Valuation: $167,000 service reconnected to the existing service, new sanitary connection to existing Existing building area: square feet 12,754 sanitary service. New building area: square feet ❑ PROPERTY OWNER TENANT' `° Number of stories: 1 Name: BioLite Plasma Services Type of construction: IIB- Fully Sprinklered Address: 10154 SW Washington Square Road Occupancy groups: B City/State/ZIP: Portland, OR, 97223 Existing: Vacant- M Phone:( ) Fax: ( 1 Nei- i =5- lee le ID APPLICANT ❑ CONTACT PERSON :NO-TICE Business name: Excel Engineering. Inc All contractors and subcontractors are required to be Contact name: Jason Daye licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 100 Camelot Drive jurisdiction in which work is being performed. If the City/State/ZIP: Fond du Lao. WI 54935 applicant is exempt from licensing.the following reasons apply: Phone:( 920) 926-9800 Fac : E-mail: jason.daye'/ exce:engliteer.cent CONTRACTOR Business name: WDS Construction BUILDING PERMIT FEES* (Please refer to fee schedule Address: 100 Tower Drive Structural plan review tee(or deposit): City/State/ZIP:Beaver Darn. WI 53916 FLS plan revieec fee(if applicable): ('hone:( 920 ) 356-1255 Fax:( ) total fees due upon application: S809-42+$300.83 CCB lie.: 205818 Amount pire ifap: 1,110.25 ob .Authorized signature: This permit application expires if a permit is not obtained 07/11/23 within 180 days after it has been accepted as complete. Print name: Jason Dave P.E. Date: * Fee meihodologv set by Tri-County Building Industry Service Board - 1:1Buildingl Permits\SIT-Perm itApp.doc 08/02/2016 440-4613TI11/02/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: 200 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) 0 cu.yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete Other:N/A *Total new impervious area including all buildings, sidewalks, and paving: 351 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: 9 Site Plan with Vicinity Map showing ADA w *Parking (including ADA) and Lighting compliance Plan-Existing to remain x Grading Plan and details ❑ *Landscaping Plan n Erosion Control Plan and details It Soils Report(if required) ',Al 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 5.00 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-I Occupancy 3 $10J6 for each additional$I 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 f ir.t$25.000.00 and $8.06 for each additional$I.01)0.00 or - - traction thereof to and including $50,000.00. $50,001.00 to$100.000.00 $540.42 for the lilt$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$1.000.00 or fraction thereof 1:ABuildingA Permits\SIT-PermitApp.doe 08/02/2016 2 City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT s l l;l� Building Permit Review — Commercial - No Land Use Building Permit #: 1A13 0U6UiD • Site Address: (WISH gut) (NctShivr Stoeur-e ref Suite/Bldg#: Project Name: boltFC 1?(aSWlot - St-f-eiWOR- (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review • ' I Proposal: Sl e4AAT t- Irein) 1"?MGGl4f 1NApc)L5 ' Q j t d StdlQ JO - MCa , v Existing Business Activity: L (LS' -Prol f'L'd Qeict, ( 7thic a j,vf Proposed Business Activity: /ut&CICaic a--'a Verify site address/suite# exists and active in permit system. River Terrace Neighborhood: ❑ Yes ..,2".No Zoning: /U,t/C. 'Permitted Use: Yes ❑ No ❑ Spec Space Confirm no land use required. gr Business License: Exists: 0 Yes No,applicant was provided a business license application Notes: µMPZ %t o?/3 - O Wad CV'Il1I✓1 J ¶/4 4 ear, AlPi✓rire(,J ( V1 pf,c.rS$°lM . No C101.e 1h (a�Mdrea ye Ctitc J J Approved by Planning: Date: 77(3/73 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: 0 Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Building Permit Submittal Original Submittal Date: 1/ Site Plans: # Building Plans: # Building Permit#: nter building p t# above. Workflow Routing: M L�fanning Permit Coordinator Q'Building Workflow Sign-off: �ign-off for Planning (include notes from planning review) Route Application Documents: Di Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: 1V fV V ()AA) Date: 1 l 11\ W v3 I:\Building\Forms\BldgPernvtRvw_COM_NoLandUse_09072022.docx Engineering Review X Slope at building pad: 5,p PFI Permit#: {.o Pl'l XConditions "Met"prior to issuance of permit X. Easements (encroachments) per engineering conditions of approval and plat(not typical on SDR/CUP) 21 Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes tg No Assess Water Quantity Fee in-lieu: ❑ Yes X No LIDA Facility on lot: ❑ Yes IX No Add Fee: ❑ Yes X.No 0 NOT Approved by Engineering: Date Notes: Approved by Engineering: 5 $(.11, 51.— Date: g- lc- 2 3 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved 0 Not Approved Revision 2: ❑ Approved 0 Not Approved Revision 3: 0 Approved 0 Not Approved Permit Coordinator Review O Conditions "Met"prior to issuance of permit O Approved,NOT Released: Date: ❑ ENG Revisions Required: Date: Notes: :, I C Exemption 0 Applied for 0 Received Does not apply \1 ees Entered: Wash Co Trans Dev Tax: 0 Yes N/A 0 Deferred Tigard Trans SDC: 0 Yes N/A 0 Deferred Parks SDC: 0 Yes N/A 0 Deferred LIDA Fee: 0 Yes ,N'N/A K to Issue/Approved by Permit Coordinator: (11� Date: 2 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 L\Building\Forms\BldgPermitRvw_COM_NoLandUse_08162022.docx