Permit 1
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit #: SIT2009 -00009
T i G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2009
. Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: Parking lot modifications, landscaping improvements, and grading.
Owner: FEES
TRIANGLE POINTE LLC Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 Permit Fee - COM 07/29/2009 $720.10
Plan Review 05/21/2009 $468.07
PHONE: Plan Review - Fire Life Safety 05/21/2009 $288.04
12% State Surcharge - Building 07/29/2009 $86.41
Contractor: Erosion Control 07/29/2009 $240.00
SD DEACON ENTERPRISES Erosion Plan Review CWS 07/29/2009 $78.00
901 NE GLISAN ST #100 Erosion Plan Review COT 07/29/2009 $78.00
PORTLAND, OR 97232
PHONE: 503 - 297 -8791
FAX: 503 - 297 -8997
Type of Use: COM
Class of Work: ADD
Site Specifics:
Excavation Volume: 1400 cu. yd.
Fill Volume: 2000 cu. yd.
Impervious Surface: 2200 sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $1,958.62
Required Items and Reports (Conditions)
1 Pln Gen REVISED LANDSCAPE PLAN -PHASE I
2 Pln Gen REVISED SITE PLAN
3 Pln Gen PLANNING INSPECTION REQUIRED
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
issuan , if work is • - •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopte• by the Oregon
Util• Notification Center. ho les a - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obi) copy of the rules
or direct questions to OUN w •y cal' g • r 46.6699 or 1.800.332.2344.
I sued By: / , Permittee Signature: i //
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro'J>ct.
Approved plans are required on the job site at the time of each inspection.
r
Building Permit Application
Site Work ; `.. � ; , j i� 0 FOR OFFICE USE ONl: \ -
City of Tigard - ' - Received �) /�
Al Permit ' '^e.• •Q QV�1�
a 13125 SW Hall Blvd., Tigard, OR 97223 2 000 Plan Review 1) j n
Phone: 503.639.4171 Fax: 503.598.1960 Mpy Date /B : , ` !L `� Other Permit: ii A tpr U' . 6 `?
T 1 GA R D Inspection Line: 503.639.4175 Date Ready /By: '• Page 2 for See
Internet: www.tigard or.gov a• , '. ; , , 50 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial /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: 13333 SW 68 Parkway New dwelling area: square feet
City/State/ZIP: Tigard, Oregon 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Triangle Pointe 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.
Parking lot modifications, landscape improvments and grading. Valuation: $$135,000.00
Existing building area: o4, 3403 square feet
New building area: I 04 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: s
Name: Deacon Development Group Type of construction: - }3
Address: 901 NE Glisan Street, Suite 100 Occupancy groups:
City/State /ZIP: Portland, Oregon 9232 Existing: A1- 3 /13
Phone: (503)297 -8791 Fax: (503)297 -8997 New: 15
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Scott Moore licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave, Suite 100 jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, Oregon 97239 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 Fax: : (503) 228-1285
E -mail: smoore @grpmack.com
CONTRACTOR
Business name: SD Deacon Enterprises BUILDING PERMIT FEES*
Address: 901 NE Glisan Street, Suite 100 (Please refer to fee schedule)
City/State/ZIP: Portland, Oregon 97232 Structural plan review fee (or deposit):
Phone: (503) 297 -8791 Fax: (503) 297 -8997 FLS plan review fee (if applicable):
CCB lic.: OR 7787 Total fees due upon application: 75 (0. 1 1
/ 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: Scott J. oo Date: 05/07/09 * Fee methodology set by Tri-County Building Industry
Service Board.
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a aa3 - "S
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. oniu ovfie !21 do
Excavation Volume: 1 00 (ric n vrt .0 cu. yds.
Grading Volume: n
(Soils report required for >5,000 cu. yds.) a,VO0 (f eni n °n e.31 le-) 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 h / t- a . ,^ct . OA(
❑ 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:
[y Site Plan with Vicinity Map showing *Parking (including ADA) and
ADA compliance Lighting Plan (t ; 61)
3 Grading Plan and details 2 *Landscaping Plan
[`' Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures
*Does not apply to One- and Two -family dwellings.
ekr0 'CA)
# of Plans
• TYPE OF SUBMITTAL ' Required at
(Includes New, Additions ;or Alterations) Submittal -
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2
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