Permit i � ° CITY OF TIGARD SITE WORK PERMIT
`= `` COMMUNITY DEVELOPMENT Permit #: SIT2009 -00006
TI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/09/2009
Parcel: 2S101AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: 2 story office and dental building - block construction net square footage under 5,000 sq. ft. per
floor 2 existing homes to be demolished
Owner: FEES
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD
BEAVERTON, OR 97007 Permit Fee - COM 09/04/2009 $462.70
Plan Review 05/11/2009 $300.76
PHONE. Plan Review - Fire Life Safety 05/11/2009 $185.08
12% State Surcharge - Building 09/04/2009 $55.52
Contractor: Erosion Control 09/04/2009 $80.00
OWNER Erosion Plan Review CWS 09/04/2009 $26.00
Erosion Plan Review COT 09/04/2009 $26.00
PHONE:
FAX:
Type of Use: COM
Class of Work: NEW
Site Specifics:
Excavation Volume: cu. yd.
Fill.Volume: cu. yd.
Impervious Surface: 22866 sq. ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall: No
Fire Underground: Yes Accessible Parking: Yes
Fence: Yes
Total $1,136.06
Required Items and Reports (Conditions) �
1 Pln �e MODIFICATIONS REQUIRE P Vl� APPRO\
2 Pin Gen EELS .__L- A FUNDS
3 Pln Gen SUB . ` COVERAG c .' DSCAPE % CA
4 Pln Gen w NDSCAPE PLAN DETAILS
5 Pln Gen FRANCHISE WASTE HAULER SIGN -OFF
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 Notific 'on Cen�Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct q estions to OUNO y g 503 46.6699 or 1.800.332.2344.
Issued B Permittee Signa•
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 project.
Approved plans are required on the job site at the time of each inspection.
a ? c o ° Si & LAS
Building Permit Application
Site Work RECEI V J
ED FOR OFFICE USE ONLY
City of Tigard MAY 1 2009 Date/By 5 1.
1 l Permit No.: 51-2004 c
_OO
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
�
C . • Phone: 503.639.4171 Fax: 503.598.1960 DateDate/By: t il Other Permit
T I GAR D -1--- ( (I Inspection Line: 503.639.4175 CITY OF TIGARD Date Read y: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION 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.
dwelling Valuation: $
❑ 1- and 2-famil
y g ❑C ommercial /industrial
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. , , - .TO ' STTE FORMATION AND LOCATION ,, - - Total number of floors:
Job site address: 10' '7 S F✓ Cbit. . J New dwelling area: square feet
City /State /ZIP: _ - , 2) el r.) 'O � - 7 1 Garage /carport area: square feet
Suite/bldg. /apt. no.: 1 1--K
Project name: 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
.. r 'DESCRIPTION Of-WORK work indicated on this application.
Pala 1Z-' ,r(, CD 1 .- Valuation: $ 7)ir C) 03 .---"
Existing building area: square feet
New building area: square feet
, SkTIOPERTY OWNER - " _ ❑ TENANT Number of stories:
Name: /v47 %._ S -e•64 , C ,y, ( Type of construction:
Address: 1 70/ i) S b`' yfC -, , ,, Occupancy groups:
City /State /ZIP: h e--4 v0h ' i Crt,, Existing:
Phone: ( , 3) r 6'y ( •L w c Fax: (S'03 6 2a 5 3 '7 New:
: - ❑. APPLICANT', , , ❑ CONTACT PERSON `- NOTICE 0 , "
Business name: 5 4 ,, 7 e All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
• under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR .
Business name: 0,0 0 f 5ii.,M e f _ BUILDING PERMIT FEES * ` ..
Address: , . '(Please refer to fee schedule) '
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application: L i 85. a t_..
11 -- / � ^, l Amount received:
Authorized signature: y / �'J This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 4 044_, ti S' ,t,.,: t / Date: S.—/ C,T 7 * Fee methodology set by Tri- County Building Industry
r Service Board.
I: \Building \Permits \SIT- PermitApp.doc 12/27/06 440- 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.
/✓� ex c J o,✓ j ../i) N A/AL-7,A,
Excavation Volume: cu. yds. v
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 5 lL/
buildings, sidewalks, and paving: =t'- a c - Tv kd-i s , q. ft. S i 1 ()tit,/
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:
❑x'" "Site Plan with Vicinity Map showing ❑ *Parking (including ADA) and
ADA compliance Lighting Plan v F f' 6i'96
Grading Plan and details *Landscaping Plan
L 1 Erosion Control Plan and details ❑ Soils Report (if required)
❑ Retaining Structures Na•
*Does not apply to One- and Two - family dwellings.
fi .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
I: \ Building \Permits \SIT- PerniitApp.doc 12/27/06 2
Site Work Permit Application
Plan Submittal Requirements
TIGARD Commercial, Multi- Family and One- & Two - Family Dwellings
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi - family R -1
occupancies. A site work permit is required for excavation, fill, grading, paving, retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing:
1) Silt fence locations.
2) Bio- filter bags /other approved barrier material surrounding catch basins.
I:\Building\Permits \SIT - PermitApp.doc 12/27/06 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb. /sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
L \Building \Permits \SIT - PermitApp.doc 12/27/06 4
PERMIT NO. -5 /,9=
CleanWater Services
Ot„ . co[nmm,i;n1eiit IS clear. LOT
EROSION CONTROL INSPECTION REPORT
•
DATE ) INSPECTOR ;V/ 7,;;;;, SUBDIVISION
OWNER/PERMITEE ; /A �a A
SITE ADDRESS 70 9 , ,,� �' �,,, .s, � , �,w, 1/4.. /Iv
APPROVED
FINAL INSPECTION
THIS SITE MEETS THE POST — CONSTRUCTION
EROSION CONTROL REQUIREMENTS SET
FORTH IN CLEAN WATER SERVICES
RESOLUTION AND ORDER.
NOTE: IF POST - CONSTRUCTION EROSION CONTROL MEASURES ARE STILL BEING
EMPLOYED ON THIS SITE TO MEET CRITERIA FOR AN APPROVED FINAL INSPECTION,
THE MEASURE(S) MUST REMAIN IN PLACE UNTIL LANDSCAPING IS COMPLETE
OR PERMANENT GROUND COVER IS ESTABLISHED.
A COPY OF THE FINAL EROSION CONTROL INSPECTION REPORT MUST BE
FORWARDED TO THE NEW OWNER, AT WHICH TIME NEW OWNER ASSUMES
THE RESPONSIBILITY FOR MAINTENANCE, REPAIR AND REMOVAL.
OTHER
THANK YOU FOR YOUR COOPERATION!
INSPECTOR "7 PHONE A,✓cei'® �°