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Permit (2)
CITY OF TIGARD SITE WORK PERMIT '' . ' COMMUNITY DEVELOPMENT Permit#: SIT2023-00019 T'GAR L"+ 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/16/2023 Parcel: 2S102AA04900 Jurisdiction: Tigard Site address: 12260 SW MAIN ST Project: Oregon Rifleworks Subdivision: None Lot: None Project Description: Re-paving and striping parking lot Contractor: JADE SMITH PAVING Owner: BLUE SHOES TIGARD LLC PO BOX 596 PO BOX 1696 WILSONVILLE, OR 97070 BEAVERTON, OR 97075 PHONE: 503-538-8660 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 08/16/2023 $484.00 Plan Review 08/16/2023 $314.60 Type of Use: COM 12%State Surcharge-Building 08/16/2023 $58.08 Class of Work: OTR Plan Review-Fire Life Safety 08/16/2023 $193.60 Project Valuation: $42,510.00 Info Process/Archiving-Sm$0.50(up to 08/16/2023 $1.00 11x17) Site Specifics: Excavation Volume: cu.yd. Fill Volume: cu.yd. Impervious Surface: sq.ft. Engineered Fill: Soil Report Required: Paving: Yes Grading: Landscaping: Site Prep: Storn Drains: Retaining Wall: Fire Underground: Accessible Parking: Fence: Total $1,051.28 Required Items and Reports(Conditions) Thispermit is issued to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other subject9 9 PP Y 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 -quires you to follow the rules a.•.te. by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952 r. 1090. Yo • ay obta' : o•y of the rules Issued By: Permittee Si. a r:: 11 � - it i I to �1.!t, 4, ,_. .,. , _ Call 503.639.4175 by 7:00 a.m.for the next available ins.,ctio dat- s, This permit card shall be kept in a conspicuous place on the job site u til co pl- the project. Approved plans are required on the job site at the time of e. - ' spe. Building Permit Application Site Work FOR OFFICE USE ONLY Cityof Tigard � Received $�L� g RECEIVE Date/By: if) Permit No.: S.��--2aa3 D D[ (L e 13125 S W Hall Blvd.,Tigard,OR 97223 Plan Review a +i v / V`~� t f _ Phone: 503.718.2439 Fax: 503.598.1960M1 Date/By: Q') Other Penult: TIGAILD Inspection Line: 503.639.4175 Date Ready/By: �p•/�� two. 61 See Page 2 for Internet: www.tigard-or.gov ❑CITY OF TIGARDNotified/Method: 01 th �� Supplemental Information TYPE 01 WORNru" *� � — REQUIRED DATA: I-AND 2-FAMILY'DWELLING El 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: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El I-and 2-family dwelling CICommercial/industrial Valuation: $ ❑ 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: 12260 SW MAIN STREET New dwelling area: square feet City/State/ZIP: TIGARD, OREGON 97223 Garage/carport area: square feet cite/bldg./apt.no.: Project name: Covered porch area: square feet Cross street/directions to job site: O(eq_c„N1 P4 lnJ�,t(!�i Deck area: square feet MAIN AND COMMERCIAL QQ �� Other structure area: square feet i11 f L)TR DDATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the t' = ai)ij1 )' IYSCRLPTION OF WORK work indicated on this application. ,tit tttl,-, RECONSTRUCTION OF ASPHALT SURFACE Valuation: S 42 ,510 . 00 ALONG WITH RE—STRIPING OF ADA Existing building area: square feet AND CAR PARKING New building area: square feet EX PROPERTY OWNER 1 ❑ TENANT Number of stories: Name: NICOLI PACIFIC, LLC Type of construction: Address: 17888 SW MCEWAN ROAD Occupancy groups: City/State/ZIP:LAKE OSWEGO, OR 97035 Existing: Phone:(503) 692-6080 Fax:( ) New: El APPLICANT 'tit PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: GREGORY A PARSONS licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 15315 SW BULL MOUNTAIN RD jurisdiction in which work is being performed.If the applicant is exempt from licensing,the following reasons ory/State/ZIP: PORTLAND, OR 97224 apply: Phone:(503) 209-6900 Fax: : ( ) E-mail: PAREXC@GMAIL.COM CONTRACTOR Business name: KEITH MINTER INC. (DBA.JADE SMITH PAVING) BUILDING PERMIT FEES* Address: PO BOX 596 (Please•eJ',/o fee schedule) City/State/ZIP: WILSONVILLE, OR 97070 Structural plan review fee(or deposit): Phone:(503) 538-8660 Fax: ( ) FLS plan review fee(if applicable): CC Total fees due upon application: e.: 173008 fa (( A' ♦ Amount received: r d i n re: 1 OR „' („<< PQLI P 1 G l.{eThis permit application expires if a permit is not obtained •within 180 days after it has been accepted as complete. Print nam G R A PAR ONS Date: 8-15-2 023 * Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Pe uts\SIT-PemiitApp.doc 08/02/2016 440-4613T(II/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: cu. yds. Grading Volume: (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) cu.yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, 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: n Site Plan with Vicinity Map showing ADA ❑X *Parking (including ADA) and Lighting compliance Plan ❑ 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 S.00 to$500 00 551.09 minimum permit tee 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 S2,000.00. $2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and Multi-Family R-1 Occupancy 3 $I0.76 for each additional$1,000 or fraction thereof,to and including $25,000.00. One-&Two-Family Dwelling 3 $25,000.01 to S50,000.00 $338.92 for the first$25,000.00 and $8.06 for each additional S 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 $42 r 510 . 00 $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 Tennits\SIT-PertnitApp.doc 08/02/2016 2 Site Work Permit Application m 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 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. n map & tax lot # n project name E site address ❑ suite number ❑ zoning ❑ applicant name ❑ applicant phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. F. 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. 1:\Building\Pen its\SIT-PennitApp.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:\Buil in P n d g\ en its\SIT-PenuitApp.doc 08/02/2016 4 City of Tigard • BUILDING DIVISION Over-The-Counter (OTC) Building & Fire Protection System Permit TIGARD Appointment Checklist Permit Record#: 5 r3—tom Lei Contact Name: Dry /44, T Phone#: j. ..rokC,i, Business Name: P� ,�N Appt. Date/Time: Sp6p3 Site Address: 1h-(,p b t.s Aic ,w Bldg/Suite#: Project Name: Offectiv L,"• G4.A.AZI New Tenant? 0 Yes 44, No Project Description: fQ.79,`d u.,,.-.4 6.-jr7ioiv, Existing Use: N/ New Use: NA_ MMD Required: El No Related Record#: APPLICATION SPECIFIC INFORMATION GENERAL INFORMATION Class of Work: pl/r Occupancy Group: V Type of Construction: J. Kj Type of Use: U Occupancy Load: 93 Oregon Specialty Code: 1.0 SPECIFICS Number of Stories: Building Height: Mixed Use: Number of Dw Units: Number of Bathrooms: Number of Bedrooms: BUILDING SQ FT-SCHOOL CET _OTHER SQUARE FOOTAGES Story Square Footage: Accessory Structure: Covered Porch: Basement: Garage: Deck: Total Square Footage: Carport: Mezzanine: SETBACKS Sideyard Setback—Left Sideyard Setback—Front Sideyard Setback—Right Sideyard Setback—Back CONSTRUCTION Exterior Walls: Openings Protected: Firewall Separation: N: S: N: S: Occupancy Separation: E: W: E: W: Access.Parking Spaces: REQUIRED ITEMS Fire Sprinklers: Fire Alarms: Smoke Detectors: Sprinkler Type: Alarm Type: Protected Corridors: Standpipe Required: Pull Stations Required: Parapet: Hazard Group: Battery Calcs Provided: Density: Cut Sheets Provided: Design Area: K Factor: Total Project Valuation: $ '}a , sf 0 FEES DUE DC Prov Rvw,COM TI—Ping $ rp SZ.3 ) Permit Fee—Add,Alt,Demo Tenant Improvements in Existing Development $ ?$2.a.$ 12%State Surcharge Project Valuation $ Plan Review,Structural Up to$4,999 $0.00 $ a_6 Q,q a., Plan Review,Fire Life Safety $5,000-$74,999 $123.00 $ Info Proc/Arch,Lg(over 11x17$2.00) $75,000-$149,999 $307.00 $ j , 0° Info Proc/Arch,Sm(up to 11x17$0.50) $150,000 and over $489.00 $ Metro CET(over$100,000) School CET(new square footage) 9 $ Tigard CET($50,000 or more) $ Hourly Rate Fee $ Hourly Rate State Surcharge $ Misc.Admin Fee Building Staff: $ Other: Date/Time: TAL FEES DUE I:\Building\Forams\OTC_BUP_FPS 012523.docc City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT C TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: i 70?--)—cX.V0 Site Address: 12Q tp0 5VJ Main g• Suite/Bldg#: Project Name: OrCgerl 9:kkkiLtNeiltl REA' i- ir-N1Qthl (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review t ,� Proposal: PJ aC&( Wow."' 1y tv t� . N1B IYIU`e,ff of fzwed a , V10 yloauct ioV, 4 lawd.yafte otrro. Existing Business Activity: L(eS of en� F6fc,y Proposed Business Activity: , Verify site address/suite#exists and active in permit system. ,B'River Terrace Neighborhood: ❑ Yes ' No Zoning: AA/'GB➢ ,Er Permitted Use: . Yes ❑ No ❑ Spec Space ..-171 Confirm no land use required. ea Business License: Exists: AYes ❑ No,applicant was provided a business license application Notes: Approved by Planning: Date: P1 ibli3 Revisions(after Building Submittal only) Reviewer Date Revision 1: ❑ Approved L Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: Site Plans: # Building Plans: # Building Permit#: CC�Enfrr building permit#above. Workflow Routing: © g ❑ Permit Coordinator lsJ--ilutldmg Workflow Sign-off: L--Slin-off for Planning(include notes from planning review) Route Application Documents: ding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: e)7?..- By Permit Technician: � —� _ Date: 5/ `j 7 I:\Building\Fomts\B IdgPemt itRvw_COM_NoLandUse_09072022.docx Engineering Review ❑ Slope at building pad: ❑ PFI Permit#: ❑ Conditions"Met"prior to issuance of 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: ❑ Yes ❑ No Add Fee: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date Notes: Approved by Engineering: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of permit ❑ Approved,NOT Released: Date: ❑ ENG Revisions Required: Date: Notes: ❑ SDC Exemption ❑ Applied for ❑ Received ❑ Does not apply ❑ Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A ❑ Deferred Tigard Trans SDC: ❑ Yes ❑ N/A ❑ Deferred Parks SDC: ❑ Yes ❑ N/A ❑ Deferred LIDA Fee: ❑ Yes ❑ N/A ❑ OK to Issue/Approved by Permit Coordinator: Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved I:1Bu ilding\FormslBld gPermilRvw_COM_NoLandUse_08162022.docx