Permit CITY OF TIGARD SITE WORK
����'�����������l7 �����Uo����� PERMIT -
. °�n�� "�n���" "°"=~"� " SERVICES � S1396-0046 "�8���i� /31�;SVKHa0BA«�7��r�0R97223 ��DG3�4/7/ PERMIT #' ' ' ' ' ' : SIT96-0
Tigard, ,: DATE • ISSUEB::.11/04/96 ^•
PARCEL :� ?all 0AA -00300 .:
SITE ADDRESS.'. .^: 14145 'SW •105TH .AVE . - ` ` • • • 1 :
SUBDIVISI{]N�.^. .•: .^. ^ '' ', ^'. ^ r ' ' • • • ' • '^' • ' ' , f - Z(]NING: R-12` ^
BLOCK. .........: • LOT.............:
, __
_ _
TYPE OF WORK: COM PAVING? ^ Y RESO. NO.:
EXCV VOLUME: 0 cy GRADING? • N VALUE— .$: 5000
FILL VOLUME: 0 cy LANDSCAPING?....: ' Y
ENG FILL?. . . . . . : N SITE PREP?� �.. ... : Y
SOILS RPT REQD?: N STORM DRAINS?.^.: Y .
• ' . • : .• -`/wr�� ` ^' IMPERV^'E�]RFACE:`'' '. ., .
\.�'
Remarks: Addition of physical therapy rooms and offices to existing struc.+.. e - " .`
Owner� ' 7 - • . • - ■ .. ' . ` . FEEE�' `.
SUNRISE HEALTHCARE type amount by date recpt
14145 SW 105TH � '' ` • '. ' PRMT^ $ 50.50 B 11/04/96 96-286083
5PCT $ 2.53 B 11/04/96 96-286083
TIGARD OR 97224 ' ' • ' • : - ' ' • • PLCK $ ' 32.83 B 11/04/9696-286083
Phone #: EROS $ 80.00 B 11/04/96 96-286083
' . ` -' • ^' ' ERPC $ ' 26.00, B 11/04/96 96-28612183
Contractor: • ERPC $ 26.00 B 11/04/96 96-286083
CONTINUUM: INC ' - ..
700 N HAYDEN ISLAND DR -' ^' •
PORTLAND OR 97217 - : ' '-� ' � ' - - ----- ' '�
Phone #: 285-3073 $ 217.86 TOTAL
Reg #..: 047339 •
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other __
applicable laws. All work will be done in accordance with
approved' plans. This permit will expire ifwork''is mot- started ___
within 18N. days. of issuance, or if work is suspended for more . • ' ____
than IN days. . - '. ^ .
- -
. � . `�
� . . -
Perm itt ee Si atur ��u�wN�
1 __ __
�� .���- ' . ' . - ` /. -. � •
Issued By: y��' ` �� � 4.1,
.
Call for inspection'- 639-4175
.
CITY OF TIGARD Site Permit Application Plan check : Ye - 67°
Recd By �./ .,,
13125 SW HALL BLVD, Private Grading, Paving, Site Accessibility Date Recd/ -
TIGA•RD; OR 97223 Retaining Structures, Utilities and Related Work Date to P.E. •%1G7
(5 ®3) 639-4171 •x304 - " --- _..._.�'- Date to DST
— - �_.. - -1
1) Q 6 Permit # i Ta DUB
Called II— l-61(
• Print or Type - : —, -: t; , ., • :
- ..._ or illegible applications will not be accepted - f
• P ect Name Utilities (Complete all that apply)
Job I �Agic 1� er LTCAS
Address Address rl"
1 i j r L . SW 10 " Storm Sewer
( `�t Linear Ft.
Nam�� 1 b ��� (�� Sanitary Sewer
Owner Mai ing d f s � /T Linear Ft.
t 1( 5 - Fresh Water
Ci (Slt Linear Ft.
tY I ( � � Zip I Phone Catch Basins
Name 1` � . • #
sir C o()ri u L( Clean Outs
M ailing Address #
1 _ ` Describe work to be done:
General ►goo N - ,�� 0�.� /9„ Do t - _ 3f z) New❑ Addition❑ Alteration❑ Repair❑
Contractor City!$tate 17 p Ph n .5^ Additional Description o g W � Work:
Attach Stai Co Co t. Board Lic. # Exp. Date al ' I — cce c%) f °-T 0-3� AP( T'
copy 1 ,
of current COT Business Tax or Metro # Exp. Date C Na 3 u ,, , ,�f .L 0 f /mkt
licenses v`� -uc- ! t "(, I t
Name .0.4- rI C�(g� Project
V / I ��v�i Valuation , .45010
Architect Mailin dres 1, "r-A--\/ �!� Plan Submittal: (3) sets containing each of the
�0 iv Q r� p D following, must accompany this application:
Ci . to ' � // I Site plan with Vii
Zp) i Ph�n�� ��� p w Vicinity Map Parking (including
Showing ADA compliance ADA) & Lighting Plan
Name Grading Plan and details Landscaping Plan
Engineer Mailing Addres Erosion Control Plan and Retaining Structures
d etai l s including calculations
City/St e Zip Phone Site Utility Plan and details Soils Report
(showing connection to (if required)
approved system)
Excavation Volume I hereby acknowledge that I have read this application, that the
(Soils report required for >5,000 cu. Yards - .information given is correct, that I am the owner or authorized
cu. yds. agent of the owner, and that plans submitted are in compliance
with Oregon State laws.
Fill Volume Signature of Owner /Agent Date
(Soils report required for >5,000 cu. Yds.)
cu. yds.
Will the fill support a structure Con ct Person Name Phone
• (Engineer required if answer is yes) _ YES❑ • NO ( 6e:
rRetainin structure? (check one) ❑Rock -- . FOR CE USE ONLY .. • •
❑ CMU Notes:' .- . .. .
❑Concrete
❑Other
Total new impervious area including all -- - -
u Land Use Case # • buildings, sidewalks, and paving j� S q. MapITL#
•
F t.
, i:ldstslsiteapp.doc -
arss
i .,
Permit # Account Description Amount Amt. Pd. Bal. Due
Build. Permit` • (BUILD)' `5 -6 cd __
- - Plumb. Permit - - (PLUMB)
Mech. Permit (MECH)
ELC /ELR Permit (ELPRMT)
State Tax (TAX) D -S 2 . S ~3
D.5'S
Bldg:
Plumb:
Mech:
ELC /ELR:
Plan Check _ _ _ _ _ _ _
• Build: (BUPPLN) 32_63.. ____ j - 32 .13
Plumb: (PLMPLN)
Mech: - . (MECPLN)
CDC Review (LANDUS)
Ccwcr rnnnor•tinn /CIA /I ICAO
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Commercial TIF (TIF -C)
Industrial TIF __ ___ " (TIF -I) -
Institutional TIF (TIF -IS)
Office TIF (TIF -O)
Mass Transit TIF (TIF -MT)
Water Quality ; — (d@�7AL�
Water Quantity (WQUAN
Erosion Control Permit (ERPRMT) F°° v
ab,oa
2_4,06
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) 2 X) -�— � �� v
Fire Life Safety _ (FLS)
TOTALS:
2.11.149,
'IVQ
Aleak
CITY OF TIGARD
Mr. John Cooper OREGON
Sunrise HealthCare
14145 SW 105th
Tigard, OR 97223
Mr. Cooper:
Thank you for calling yesterday inquiring about the Traffic Impact Fee (TIF) assessment
calculation. TIF is based upon the applicant's permit submittal documents and our best
estimate of what type of project is involved.
Based on our conversation and the additional information identifying Sunrise Healthcare
as a NURSING HOME, and that the planned addition is auxiliary to existing operations,
and that no additional beds will be added as a result of your plan, there will be NO
Traffic Impact Fee assessed. This has been confirmed verbally by Mr. Scott King,
Washington County Traffic Impact Fee Coordinator. Please disregard the initial notice
mailed to you.
If you have any further questions, please contact me directly at 639 -4171, ext. #322.
Sincerely,
J Aldrich
Customer Service Supervisor
Community Development
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772