Permit CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2023-00013
Date Issued: 7/19/2023
T f G pg.0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S103DC01100
Jurisdiction: Tigard
Site address: 11075 SW GAARDE ST A
Project: Grace Point Community Church Subdivision: None Lot: None
Project Description: Removing 2900 sq ft of asphault to create new playground.
Contractor: ALL ABOUT CONCRETE&MASONRY LLC Owner: FIRST BAPTIST CHURCH OF TIGARD,THE
9450 S HEINZ RD 11075 SW GAARDE ST
CANBY, OR 97013 TIGARD,OR 97223
PHONE: (503)747-9777 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Plan Review 06/21/2023 $33.21
12%State Surcharge-Building 07/19/2023 $6.13
Type of Use: COM Info Process/Archiving-Sm$0.50(up to 07/19/2023 $2.00
Class of Work: ALT 11x17)
Permit Fee-Site Work 07/19/2023 $231.32
Project Valuation: $14,500.00 Plan Review 07/19/2023 $117.15
12%State Surcharge-Building 07/19/2023 $21.63
Erosion Control w/Development 07/19/2023 $80.70
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 2900 sq.ft.
Engineered Fill: Soil Report Required:
Paving: No Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall: Yes
Fire Underground: Accessible Parking:
Fence:
Total $492.14
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 follow the rules adopted by the Oregon
Utility Notification Center. o•e 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: ( � (�✓✓'
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.
Bualding Permit Application
Site Work RECEf FOR oFF1CF . ON
Cl of Tiand 'eceived 1 r t
IL "J g ��t,,•.,J 1 2 Date/By: � /f d� Permit No.: `,TT- aW!3`GWi s
tdril • 13125 SW Hall Blvd.,Tigard,OR 97223 1 0 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 7 ' Other Permit:
Date By:
"f 1 GAKD Inspection Line: 503.639.4175 CITY OF TIG A Date Ready/By: Jeris: ® See Page 2 for
�A�P1 Notified/Method: 7 6 a3 SupplementalInformation
Internet: www.tigard-or.gov BUILD!ILr- DIVJs1' N FWta .�
prevl
TYPE OF WORK REQUIRED 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
tif 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 ElCommercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
1 Job site address: `r 0 75- S,42, C'�42,... --0,e New dwelling area: square feet
City/State/ZIP: --IG��..CZ"� C)� , 7aZ Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: �racz ��1,,,_. Covered porch area: square feet
Cross street/directions to job site: T>L4A er, @sUu#—.)(::. Deck area: square feet
tt j/eD t}- C-,l4...4_e_io I , 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.: 'Ti&)C L.C, 1100 2.S 1 03 Da equipment,
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. 021
roL' - ,4'vPlute.. r -eL' .c_ ,CJ, 'rt4 -4- �v V =- $ / L ,5 7
• C CJr 6/f,)t4/ 2 AN'UVN tom',e' t wt„T�Y Existing building area: square feet
New building area: square feet
t PROPERTY OWNER 0 TENANT Number of stories:
Name: C&-z - >i�- Co V�i.,tt r C V�^ N Type of construction:
Address:f 2�]5 .(it>. �� 41Z`t� ✓ .j i Occupancy groups:
City/State/ZIP: —t'I +�(�� CJVZ- Q 2Z� Existing: ,
to Phone:(T),3 ) G3 9—3 9/ 3 Fax:( )
New:
Er APPLICANT K( CONTACT PERSON NOTICE
Business name: C>VLEG,,.._pe_,t'alt �4,y,✓t�(✓,'0-t t � t, All contractors and subcontractors are required to be
Contact name: yt1 1..„...) , (,...cc., licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: // 7. — ,, . f, G txvie_ c--1-, jurisdiction in which work is being performed.If the
City/State/ZIP:"7^i6, reQ Cjt2 �--7 2 2 eF applicant is exempt from licensing,the following reasons
apply:
Phone:(58 ) 3 jGj__7343 Fax: :( )
E-mail:-j lelt51rACe---Pc)i0-'-t ' sari"I7 . C_LJWt.
CONTRACTOR
Business name: /4'4_4_ , _,-r W?- t' T�- BUILDING PERMIT FEES*
Address: (2 V- jO-�V.P tPleaserefer m fee schedxle_)
City/State/ZIP: Ic Structural plan review fee(or deposit): "31 a\
G,t�r�6 Y o��5c4-'
Phone:(5b3) 7t}? - I-7 -7-7 Fax:( ) FLS plan review fee(if applicable):
Total fees due upon application:
CCB lic.: 2 2 1 a 37
<< ll / �� Amount received:
Authorized signature -�` 7.1... /�� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Jlav c Z. lit,)I`LSC Date: Co-21 -z3 * 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)
I
City of Tigard
111111 C a COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Commercial - No Land U s e
Building Permit #: `JET - , 7-- 1-^,)
Site Address: 114T7 C1n4 GAAgpE S-r Suite/Bldg#:
Project Name: G R V },► "
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: P iiJ ?(,A� 42--00n1D
Existing Business Activity: (}43 fl
Propose Business Activity: C If t/I2c(}-
Verify site address/suite# exists and active in permit system.
❑ Ri errace Neighborhood: CI Yes 1V v
Ptiftr nin : 3
ed Use: Yes ❑ No ❑ Spec Space
nfirm no land use required.
Business License:
Exists: ❑ Yes No,applicant was provided a business license application
Notes: •
Approved by Planning: Date: Co 4/ /Z��
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 61�4 3
Site Plans: #
Building Plans: #
Building Permit#: Q.—Enter building permit#above.
Workflow Routing: ❑—Planning Q--Permit Coordinator [Building
Workflow Sign-off: 2--Sign-off for Planning(include notes from planning review)
Route Application Documents: El Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: f l • ' JL4 Date: (p/ 3/c
I:\Building\Forms\BldgPermitRvw_COM_NotandUse_09092022.docx
Engineering Review
� i
[l�Slope at building pad: l/0
FI Permit#:
0,_ ❑ Conditions "Met"prior to issuance of permit❑ Easements (encroachments)per engineering conditions of approval and-Oat (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 0 No Add Fee: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date: Z/3/23
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
Permit Coordinator Review
\(K Conditions "Met"prior to issuance of permit
❑ Approved,NOT Released: Date:
0 ENG Revisions Required: Date:
Notes:
iffrSDC Exemption ❑ Applied for ❑ Received Does not apply
•GifFees Entered: Wash Co Trans Dev Tax: 0 Yes N/A ❑ Deferred
Tigard Trans SDC: ❑ Yes N/A 0 Deferred
Parks SDC: ❑ Yes N/A ❑ Deferred
LIDA Fee: ❑ Yes N/A
OK to Issue/Approved by Permit Coordinator: k
iCb1�\[C` Date: '.). —5
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B IdgPennitRvw_COM_NoLandUse_08162022.docx
RECEIVED
JUL 19 2023 CleanWatei;ervices
SENSITIVE AREA PRE-SCREENING SITE ASSESA VAR N �
Clean Water Services File Number T 23-001906
1. Jurisdiction: Tigard
2. Property Information(example: 1 S234AB01400) 3. Owner Information
Tax lot ID(s): Name: Jim Wilson
1 100 2S 1 03DC Company: Grace Point Community Church
Address: 11075 SW 90th Ave.
OR Site Address: 11075 SW 90th Ave. City, State,Zip: Tigard,Oregon,97224
City, State,Zip: Tigard,Oregon,97224 Phone/fax: 5033197343
Nearest cross street: Email: jim@gracepointfamily.com
4. Development Activity(check all that apply) 4. Applicant Information
❑ Addition to single family residence(rooms,deck, garage) Name: Jim Wilson
❑ Lot line adjustment 0 Minor land partition Company: Grace Point Community Church
❑ Residential condominium ❑ Commercial condominium Address: 11075 SW 90th Ave.
❑ Residential subdivision 0 Commercial subdivision City, State,Zip: Tigard,oregon,97224
❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 5033197343
Other Building a playground at our church. Email: jim@gracepointfamily.com
6. Will the project involve any off-site work? ❑Yes ❑x No 0 Unknown
Location and description of off-site work:
7. Additional comments or information that may be needed to understand your project:
We are removing 2900 SQ.Ft.of parking lot asphalt&putting in a children's playground area...curbed with wood chips.
This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits,Site
Development Permits, DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality,
Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and
completed under applicable local,state,and federal law.
By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water
Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering
information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my
knowledge and belief,this information is true,complete, and accurate.
Print/type name Jim Wilson Print/type title Church Administrator
Signature ONLINE SUBMITTAL Date 6/22/2023
FOR DISTRICT USE ONLY
O Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO
ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural
Resources Assessment Report may also be required.
❑ Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the
site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if
they are subsequently discdvered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5, Section
3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable
local,State and federal law.
CI Based on review of the submitted materials and best available information the above referenced project will not significantly impact the
existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to
evaluate and protect additional water quality sensitive areas if they are subsequently discovered. This document will serve as your Service
Provider Letter as required by Resolution and Order 19-5, Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and
approvals must be obtained and completed under applicable local,state and federal law.
❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S) ARE ATTACHED.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT
OR SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by ( _/CB6lelet4 Date 7/17/2023
On complete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services,2550 5W Hillsboro Highway, Hillsboro,Oregon 97123
zrzozo
Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org
- --_,
,,,,
6 tee av '
COMMUNITY CHURCH • , 2023
CITY OF TIGARD
FL)/LL !tii rld>SI ry
Oct. 15, 2022
To whom it may concern,
Please accept this letter as authorization for Jim Wilson to sign any documents
having to do with City of Tigard permits.
Jim is our Church Administrator and has the Board of Elders' permission and
confidence to sign for and represent our church in such matters.
Sincerely,
Douglas Winn
Chairman of the Board
Gracepoint Community Church
Tigard, OR 97224
www.GracePointFamily.com 1503.639.3913 111075 SW Gaarde St,Tigard,OR 97224-3720
- ,n Washington County,Oregon 2023-024616
Alter record1n return to; � iM4D-DBS 06115/2023 12:10:57 PM
Stn=2 S AKINS
First Baptist Church of Tigard
Z 1 2023 $10.00$11.00$5.00$60.00$20.00 $106.00
I,Joe Nelson,Director of Assessment and Taxation and ExAtficio
11075 SW Gaarde Street County Clerk for Washington County,Oregon,do hereby certify that
Ti and OR 97224 CITY OF TIGARD*{ the within instrument of writing was received and recorded in the
g BUILDING DIV'i` ION book of records of said county.
Joe Nelson,Director of Assessment and
Taxation,Ex-Officio County Clerk
Send Tax Statements to:
First Baptist Church of Tigard
11075 SW Gaarde Street
Tigard, OR 97224 DEED
First Baptist Church of Tigard, an Oregon nonprofit corporation, Granter, conveys to,
a - First Baptist Church of Tigard, an Oregon nonprofit corporation, Grantee,the following
'—' real property situated in Washington County, Oregon, See attached exhibit.
cl) BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT,THE PERSON TRANSFERRING FEE
c.f.\ TITLE SHOULD INQUIRE ABOUT THE PERSON'S RIGHTS,IF ANY,UNDER ORS 195.300,
195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11,CHAPTER 424,OREGON LAWS 2007,
AND SECTIONS 2 TO 9 AND 17,CHAPTER 855,OREGON LAWS 2009. THIS INSTRUMENT
DOES NOT ALLOW USE OF THE PROPERTY DESCRIBED IN THIS INSTRUMENT IN
VIOLATION OF APPLICABLE LAND USE LAWS AND REGULATIONS. BEFORE SIGNING OR
1 ACCEPTING THIS INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE PROPERTY
F-'- SHOULD CHECK WITH THE APPROPRIATE CITY OR COUNTY PLANNING DEPARTMENT TO
VERIFY THAT THE UNIT OF LAND BEING TRANSFERRED IS A LAWFULLY ESTABLISHED
1 LOT OR PARCEL,AS DEFINED IN ORS 92.010 OR 215.010,TO VERIFY THE APPROVED USES
0 OF THE LOT OR PARCEL,TO DETERMINE ANY LIMITS ON LAWSUITS AGAINST FARMING
OR FOREST PRACTICES,AS DEFINED IN ORS 30.930,AND TO INQUIRE ABOUT THE RIGHTS
OF NEIGHBORING PROPERTY OWNERS,IF ANY,UNDER ORS 195.300, 195.301 AND 195.305 TO
195.336 AND SECTIONS 5 TO I 1,CHAPTER 424,OREGON LAWS 2007,AND SECTIONS 2 TO 9
AND 17,CHAPTER 855,OREGON LAWS 2009.
The true consideration for this conveyance is permit requirement of City of Tigard.
Dated this /5-day of June 2023.
James R. Wilson
Church Administrator
First Baptist Church of Tigard
STATE OF OREGON, County of Washington )ss
CC�7
)n1s instrument was acknowled ed be for me on/�ttay of.June 2023 b —.1 a/Yle ,/son
$5 C-'fLcc,- 1- Cldr 1n`rishRlo 7 of Fe -c 4r
Cht -rya4ttl I»re) flafv-r �p
`J OFFICIAL STAMP
GEORGINA H PERKINS64j-I ' 14
" `� NOTARY PUUBLICGON
` i� COMMISSION NO.1009019
MY COMMISSION EXPIRES FEBRUARY 10,2025
Notary Public for Oregon
a
EXHIBIT
A tract of land situated in the Southeast Quarter of Section 3,Township 2 South, Range 1 West,
Willamette Meridian, also being a portion of Book 427, Page 711 and Book 752, Page 930, and Book 463,
Page 436, Washington County Deed Records, being more particularly described as follows:
Beginning at a point on the west right-of-way line of Southwest 110th Street,said point being located
North 89°28'19" East, a distance of 1189.21 feet and North 00°19'02"West,a distance of 49.93 feet
from the south quarter corner of said Section 3, being a 2" brass cap in a monument box;Thence on the
said west right-of-way line of SW 110th street North 00°19'02"West,a distance of 610.68'to the south
line of the Plat of Fairhaven Court, a duly recorded plat in Washington County Plat Records;thence on
the South line of said Plat of Fairhaven Court and the south line of the Plat of Exodus,also a duly
recorded plat in Washington County Plat Records South 89°27'23"West,a distance of 263.57 feet to the
easterly line of Document No.87-36832,Washington County Clerk Records,said point also being 7.50
feet westerly of a 15 foot wide sewer line easement as described in Washington County Circuit Court
Final Judgement No. 31-227 and being 7.50 feet from centerline when measured at right angles;Thence
on the westerly line of said sewer line easement and on the easterly line of said Document No.87-36832
and Document No.89-21833,South 11°38'31"West,a distance of 228.24 feet to an angle point;thence
continuing on the westerly line of said sewer line easement and easterly line of Document No. 89-
21833,South 01°21'37" East,a distance of 92.34 feet to the southeasterly corner of said Document No.
89-21833;Thence leaving the westerly line of said sewer line easement and on the southerly line of said
Document No.89-21833,South 89°27'23"West, a distance of 59.29'to the east line of Book 674, Page
273,Washington County Deed Records;Then on the said east line of said Book 674, Page 273 South
00°43'59" East, a distance of 124.98 feet to the north line of Document No.2002-150970,Washington
County Deed Records;thence on the north line of said Document No.2002-150970, North 89°28'19"
East,a distance of 33.00 feet to the northeast corner thereof;thence on the east line of said Document
No. 2002-150970,South 00°43'27" East, a distance of 182.10 feet to the north right-of-way line of SW
Gaarde Street as described in Document No.2006-020490,Washington county Deed records, being 38
feet from centerline when measured at right angles;thence on the said north right-of-way line of SW
Gaarde Street N89°28'19" East,a distance of 329.32 feet to the beginning of a non-tangent 20.00 foot
radius curve to the left(the radius point bears North 53°39'29"West);thence on said curve through a
central angle of 36°39'32" (the long chord of which bears North 18°00'44" East,a distance of 12.58 feet)
an arc distance of 12.80 feet to the point of beginning.
Containing 199, 506 square feet or 4.58 acres.
Basis of bearing based on SN 30047 being North 89°28'19" East on the centerline of SW Gaarde Street.