Loading...
Permit q CITY OF TIGARD SITE WORK PERMIT 111 ' COMMUNITY DEVELOPMENT Permit #: SIT2010 -00026 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/08/2011 Parcel: 1 S135CA90125 Jurisdiction: Tigard Site address: 11046 SW GREENBURG RD 125 Project: Ash Creek Condominiums Subdivision: ASH CREEK CONDOMINIUMS Lot: 0 Project Description: New fire line and vault for service building addressed as 11046 & 11048 SW Greenburg Rd. Contractor: WESTERN STATES FIRE PROTECTION Owner: PHIL- ALEXANDER, LORRAINE 13896 FIR ST STE B 11046 SW GREENBURG RD #125 OREGON CITY, OR 97045 TIGARD, OR 97223 PHONE: 503 - 657 -5155 PHONE: FAX: 503 - 657 -5182 FEES Description Date Amount Specifics: Permit Fee - Site Work 02/08/2011 $427.58 Plan Review 12/29/2010 $277.93 Type of Use: MF 12% State Surcharge - Building 02/08/2011 $51.31 Class of Work: ALT Plan Review - Fire Life Safety 12/29/2010 $171.03 Project Valuation: $35,550.00 Site Specifics: Excavation Volume: cu. yd. Fill Volume: cu. yd. Impervious Surface: sq. ft. Engineered Fill: Soil Report Required: Paving: Grading: Landscaping: Site Prep: Storn Drains: Retaining Wall: Fire Underground: Yes Accessible Parking: Fence: Total $927 85 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 start • i 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules - dopted by the Oregon Utility • ica i• -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -01 • I. You may 'tain a • spy of the rules or •' ect questions to O. -fling 503.232.1987 or 1.800.332.2344. 1-, ued By: /� Per mittee Signatur \ _ _ �_ �w i. . 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 FOR OFFICE USE ONLY City of TigarR EC � . D 4,11 If /0 , / Permit No-: A rAp /0 �4dm ,A 9' " 13125 SW Hall Blvd., Tigard, OR 44+ Plan R Phone: 503.639.4171 Fax: 503.598.1960 2010 Date/B : 'hQ , Qther Permit. /D -Gdit �( T l Ci A R D Inspection Line: 503.639 DEC 2 9 D ate Read �?� Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: )1 1 1 I Supplemental Information TIGARD 1.-0(1 .. >4� Da r r•t TYPE OF Wb REQUIRED DATA: 1- AND 2- FAMILY DWELLING gNew 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 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: i 1 0 4 ( o S (A) t:Yre.e r* U o . New dwelling area: square feet City/State/ZIP: Tt ( ,r4 , O R. Garage/carport area: square feet Suite/bldg.apt.no.: Project name: 15r1 Cr CO -.L 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. 'C\ W Z 't \w ' \t0\u. \ Sc Valuation: $ 2)5 , Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State /ZIP: Existing: Phone: ( ) Fax: ( ) New: APPLICANT CONTACT PERSON NOTICE Business name: k_Ur?Svel 5 c -w ?cafe G." Cu All contractors and subcontractors are required to be Contact name: (.\ f �� �� Cf1 k licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1 $ cu i . \ 5't/likt (3 jurisdiction in which work is being performed. If the r C applicant is exempt from licensing, the following reasons City/State /ZIP: ©,C .QCs t C.7 F- �-1v�cS apply: Phone: (j 03) I,p 1 - `5t SS Fax: : (5O 3) (051 - St eia E -mail: rstl\ - Nu\ e (� p . k4 $5 7 • 5 ���$. CONTRACTOR i�� • 7 I G 57-'31 Business name: ` - )C+ tV\c' 06 AC ,je BUILDING ERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee (or deposit): City/State /ZIP: Phone: ( ) I Fax: ( ) FLS plan review fee (if applicable): CCB lic.: D 4 $"1 O Total fees due upon application: Amount received: Authorized signature: atvaajt fl it / p J ��w�,��`'A�. This permit application expires if a permit is not obtained Date: < within 180 days after it has been accepted as complete. Print name: Da r NI ( r 1 u i� \ 2 - 2 \ - 1 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\ .SIT - PermitApp.doc 10/01/09 440- 4613T(11 /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: ❑ Site Plan with Vicinity Map showing ADA ❑ *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 $.00 to $500.00 $51.09 minimum permit fee 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 2 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 - Occupancy 2 $10.76 for each additional $1,000 or fraction thereof, to and including $25,000.00. One & Two - Family Dwelling 2 $25,000.01 to $50,000.00 $338.92 for the first $25,000.00 and $8.06 for each additional $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 $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. I:\Building\Permits \SIT - PermitApp.doc 12/27/06 2 - I I Z-0 10-00c) Z6 c:ONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR U NDERGROUND PIPING 'ROCEDURE Jpon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be :orrected and system left in service before contractor's personnel finally leave the job. ■ certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood he owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving ruthority's requirements or local ordinances. 'ROPERTY NAME C ` (reek Date (; h 'ROPERTY ADDRESS �D �� 1 t I 0 SIA ewe, ACCEPTED BY APPROVING AUTHORITY('S) f aMES ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS EQUIPMENT USED IS APPROVED YES ❑ NO YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ® YES ❑ NO OF CONTROL VALVES AND. CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN LEFT ON THE PREMISES? ® YES ❑ NO IF NO, EXPLAIN ® YES ❑ NO LOCATION SUPPLIES BUILDING: El YES ❑ NO PIPE TYPES AND CLASS TYPE JOINT PIPE CONFORMS TO NFPA -24 STANDARD ® ❑ NO • UNDERGROUND FITTINGS CONFORM TO NFPA -24 STANDARD YES ❑ NO YES PIPES IF NO, EXPLAIN AND JOINTS JOINTS NEEDING ANCHORAGE CLAMPED, STRAPPED, OR BLOCKED IN ® ❑ NO ACCORDANCE WITH NFPA -24 STANDARD YES IF NO, EXPLAIN FLUSHING. Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow -offs. Flush at flows not less than 390 GPM (1476 Umin) for 4 -inch pipe, 880 GPM (3331 Umin) for 6 -inch pipe, 1560 GPM (5905 Umin) for 8 -inch pipe, 2440 GPM (9235 L /min) for 10 -inch pipe, and 3520 GPM (13323 Umin) for 12 -inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. HYDROSTATIC. Hydrostatic tests shall be.made not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi TEST (10.3 bars) for two hours. DESCRIPTION LEAKAGE. New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at the joints. The amount of leakage at the joints shall not exceed 2 qts. Per hr. (1.89 Uh) per 100 joints Irrespective of pipe diameter. The leakage shall be distributed over all joints. If such leakage occurs at a few joints the installation shall be considered unsatisfactory and necessary repairs made. The amount of allowable leakage specified above may be increased by 1 f. Oz per in. Valve diameter per hr. (30 mL/25 mm/h) for each metal seated valve isolating the test section. If dry barrel hydrants are tested with the main valve open, so the hydrants are under pressure, an additional 5 oz per minute (150 mUmin) leakage is permitted for each hydrant. NEW UNDERGROUND PIPING FLUSHED ACCORDING TO NFPA -24 STANDARD ❑ NO 'I BY (COMPANY) YES IF NO, EXPLAIN • HO FLUSHING FLOW WAS OBTAINED THROUGH WHAT TYPE OPENING FLUSHING PUBLIC WATER ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ HYDRANT BUTT OPEN PIPE TESTS LEAD -INS FLUSHED ACCORDING TO NFPA -24 STANDARD ® ❑ NO BY (COMPANY) YES IF NO, EXPLAIN HOW FLUSHING WAS OBTAINED THROUGH WHAT TYPE OPENING PUBLIC WATER ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ Y CONN. TO F & SPIGOT ❑ OPEN PIPE (OVER) . . ,tip ALL NEW UNDERGROUND PIPING HYDROSTATICALLY TESTED AT JOINTS COVERED HYDROSTATIC pSl ?I i FOR 2 HOURS C - ° G'l, to�� YES ❑ NO OTAL AMOUNT OF LEAKAGE MEASURED LEAKAGE GALS. HOURS TEST ALLOWABLE LEAKAGE GALS. HOURS HYDRANTS NUMBER INSTALLED I TYPE AND MAKE ALL OPERATE ATISFACTORILY ❑ YES ❑ NO WATER CONTROL VALVES LEFT WIDE OPEN �_ �y ❑ YES ONO CONTROL IF NO, STATE REASON W 4 . Vnp Pwe r- VALVES HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH THOSE OF FIRE DEPARTMENT ANSWERING ALARM ❑ YES ❑ NO DATE LEFT IN SERVICE • REMARKS NAME OF INSTALLING CONTRACTOR: deo Western States Fire Protection Company TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES I I FOR INSTALLING CONTRACTOR (Sfl.-- TITLE DATE ir- i, /�rv- "D I r rrmn a 1 1C' - f9 - I l FOR LOCAL FIRE MARSHAL (SIGNE ,/ TITLE DATE ? �2w t I r/VSI a(� I ti-)--/-// FOR RESPONSIBLE MANAGING EM E TITLE DATE I Jeff Murphy (Project Manager) I DDITIONAL EXPLANATION AND NOTES (BACK)