Permit (5) -14 �r CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2021-00007
'T,GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/4/2021
Parcel: 2S103DD00700
Jurisdiction: Tigard
Site address: 13769 SW PACIFIC HWY
Project: Dutch Bros Coffee Subdivision: None Lot: None
Project Description: New Dutch Bros Coffee building. Existing buildings demolished under separate permit.
Contractor: LUNA DESIGN &CONSTRUCTION LLC Owner: GROUND 99 LLC
1709 NE CONIFER BLVD 610 SW ALDER ST STE 1221
CORVALLIS, OR 97330 PORTLAND, OR 97205
PHONE: 503-702-1851 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/03/2021 $648.02
Plan Review 04/21/2021 $421.21
Type of Use: COM 12%State Surcharge-Building 05/03/2021 $77.76
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 05/03/2021 $20.00
11x17)
Project Valuation: $60,817.30 Erosion Control w/Development 05/03/2021 $161.40
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 2000 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 $1,328.39I
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. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
Building Permit Application
/ , it 1
Site Work RECEIVE 1 FOR OFFICE USE ONLY
City of Tigard Received 121 �p 7 (1, rg0t ^�^7
1a!t r nrt+,r Date/ y:,UT / LvG� �� Permit No.: LV�"'QV(;(f
IIIII a 13125 SW Hall Blvd.,Tigard,OR 97223 Jk.. ut; Plan Review
9 Phone: 503.718.2439 Fax: 503.598.1960 3 -a.) Other Permit:
Inspection Line: 503.639.4175 CITY
T n 1�C Date By.
TIGARD p VII 1 OF 115.�rirl�J Date Ready/By: Iuris: Supplemental See Ifor
nformation
Internet: www.tigard-or.gov Notified/Method:5-4/21 Information
BUILDING DIVISI0 -E ,' / /nU tt-� r511
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
il 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-famil dwelli Valuation: $
Y n g I�CommerciaL'industrial
Accesso buildin Number of bedrooms:
❑ ry g ❑Multi-family
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 3769 SW Pacific Hwy New dwelling area: square feet
r ° City/State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite bidg./apt.no.: Project name: Dutch Bros. Coffee Covered porch area: square feet
Cross street/directions to job site: 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.
� Tax map/parcel no.: 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.
Ct
New Dutch Bros. Coffee building. Existing buildings demolished under Valuation: $ 69,817.50
separate demolition permit. Existing building area: 0 sq uare feet
New building area: 500 square feet
MI PROPERTY OWNER 0 TENANT Number of stories: 1
Name: Ground 99 LLC Type of construction: V-B
Address: 13640 Birdshill Rd Occupancy groups:
City/State/ZIP: Portland, OR 97219 Existing:
Phone:( ) Fax: ( )
New: B
❑ APPLICANT III CONTACT PERSON
NOTICE
Business name: Studio 3 Architecture, Inc. All contractors and subcontractors are required to be
Contact name: Matt Johnson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 275 Court St NE jurisdiction in which work is being performed.If the
City/State/ZIP:Salem, OR 97301 applicant is exempt from licensing,the following reasons
apply:
Phone:(503) 390-6500 Fax: :( )
E-mail: matt@studio3archtitecture.com
CONTRACTOR
Business name: Luna Design and Construction BUILDING PERMIT FEES*
Address: 1709 NE Conifer Blvd (Please refer tofee schedule)
City/State/ZIP: Corvallis, OR 97330 Structural plan review fee(or deposit): /21.2,
Phone:(541 ) 224-8257 Fax:( ) FLS plan review fee(if applicable):
CCB lic.: 200358 Total fees due upon application:
Amount received:
Authorized signature: h This permit application expires if a permit is not obtained
Print name: Matt Johnson Date: 12/16/2020
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
iI:\Building\Permits4SIT-PermitApp.doc 08/02/2016 4401413T(1l/02/COM WEB)
r
City of Tigard
114 COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - With Land Use
1IUAI:D
Building Permit #: S! TZ0Z/-00007
Site Address: 13769 SW Pacific Highway Suite/Bldg#:
Project Name: Dutch Brothers Coffee
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Plat101IR Review
Proposal: Site work only
Xl Verify site address/suite# exists and active in permit system.
i] River Terrace Neighborhood: ❑ Yes E No
® Land Use Case#: SDR2020-00003
X Plans Match Approved Land Use:
XI Site Plan V Landscape Plan gl Other: ph ll,nle}rles
183, Urban Forestry Plan r( Elevation Plan
na Building Height: Maximum Height Actual Height
0 Conditions Met: [Al Prior to Submittal 0 Prior to Permit Issuance
® Business License:
Exists: ❑ Yes ® No,applicant was provided a business license application
® Public Facilities Improvement(PFI) Permit PFI2020-00494
Required: Xl Yes,applicant was notified ❑ No Applied For: ® Yes ❑ No, stop intake
Notes: Meet conditions prior to issuance.
Approved by Planning: Date: 4 13 202t
Revisions (after Building Submittal on y) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved 0 Not Approved
8trildiok Perolit Stioniittal
Original Submittal Date: p/'20 2&2/
Site Plans: # ..
Building Plans: # 3
Building Permit #: Er-Enter building permit# above.
Workflow Routing: "Planning Li 'Engineering Permit Coordinator CYBuilding
Workflow Sign-off: Cil'Sign-off for Planning(include notes from planning review)
Route Application Documents: 0/Building: original permit application,site plans,building plans, engineer and
beam calculations and trus :e .ils,if applicable, etc.
Notes: /
By Permit Technician: /%//n/n'
�� v Date: 0/2471
I:1Buil ding\Forms1B IdgPermitRvw_COM W ith LandUse_111819.docx
Eizgii eerit1R i evie p
Z.---Slope at building pad: 3 C 0
Cr PFI Permit#: f FJ Z ozo —Od q q 4
❑'Conditions "Met"prior to issuance of building permit
Ti Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
11 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes C'r No
Assess Water Quantity Fee in-lieu: ❑ Yes Ev-No
LIDA Facility on lot: [ 'Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Y� t Date: 9 —/ U - Z
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Aerrr?it Cootcfri for Review
Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
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 f N/A
Tigard Trans SDC: ❑ Yes tg N/A
Parks SDC: ❑ Yes N/A
XOK to Issue Permit Approved by Permit Coordinator: Date: 4f2
1)20z'i
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