Permit CITY OF TIGARD SITE WORK PERMIT
• COMMUNITY DEVELOPMENT Permit #: SIT2012 -00004
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S110DC00500
Jurisdiction: Tigard
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW -BROOK -FARM Lot: 17
Project Description: Site work for a new 3,815 sq. ft. commercial building.
Contractor: PHAIR CONSTRUCTION COMPANY Owner: CDBK PROPERTIES LLC
PO BOX 4722 11565 SW DURHAM RD BLDG F 100
SALEM, OR 97032 TIGARD, OR 97224
PHONE: 503 - 545 -9583 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 06/27/2012 $674.92
Plan Review 03/28/2012 $438.70
Type of Use: COM 12% State Surcharge - Building 06/27/2012 $80.99
Class of Work: ALT Info Process /Archiving - Lg $2.00 (over 06/27/2012 $18.00
11x17)
Project Valuation: $75,000.00 Erosion Control 06/27/2012 $80.00
Erosion Plan Review CWS 06/27/2012 $26.00
Erosion Plan Review COT 06/27/2012 $26.00
Site Specifics:
Excavation Volume: 500 cu. yd.
Fill Volume: 50 cu. yd.
Impervious Surface: 4000 sq. ft.
Engineered Fill: No Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence:
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Total $1,344.61
Required Items and Reports (Conditions)
1 Ersn Cntrl 503 - 681 -4444
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 Noti • enter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direr uestions to • • c• (ling 503.232.1987 or 1.800.332.2344.
Issue By: I /, 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 - ' ..
Site Work ,\ C 5) FOR OFFICE USE ONLY
City g
Cit of Tigard Received , .
`J �� Daie(B h /t 7/I i . /.. h
° 13125 SW Hall Blvd., Tigard, OR 97223 r�Q\
,
D Phone: 503.718.2439 Fax: 503.598.1960 l� R� k ...-� Oth P 3
T I G A R D Inspection Line: 503.639 �Qt� �� ; ��i � +; \'' dy/ : y: � � mds: See Page 2 or
Int www.tigard- or `` ` • ed /Method: 67N I' (( 7 , Supplemental Information
O �
TYPE OF WORK Gl %4e 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.
Valuation: $
❑ I- and 2- family dwelling ® Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
r / Li 5 - 5 ....— JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:j.144nW Summerfield Dr New dwelling area: square feet
City /State /ZIP: Tigard Oregon, 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: Swhwindt Dental Office Covered porch area: square feet
Cross street/directions to job site: SW Durham Rd Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 500 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S1 W IODC 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.
Demolish existing building and construct new office. Construct parking lot, Valuation: $$75,000.00
sidewalk, and swale. Existing building area: 1,000 square feet
New building area: 3,815 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: I
Name: CDBK Properties LLC Type of construction: VB
Address: 11565 SW Durham Rd, Bldg F, Suite 100 Occupancy groups:
City /State /ZIP: Tigard OR 97219 Existing:
Phone: (503)322 -8450 Fax: ( ) — New: B
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: KASA Architects All contractors and subcontractors are required to be
Contact name: Kevin Saxton licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4119 NE Cesar E Chavez Blvd jurisdiction in which work is being performed. If the
City /State /ZIP: Portland Oregon 97211 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 284 -6917 Fax::( )
E -mail: ksaxton @kasapdx.com
CONTRACTOR
Business name: EmmettAPhair Construction BUILDING PERMIT FEES*
Address: PO Box 4722 (Please refer to fee schedule)
City /State /ZIP: Salem, Oregon 97032 Structural plan review fee (or deposit):
Phone: (503) 545 -9583 Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: 5711,2'I tb9-0 Total fees due upon application: 4 4/ii Amount received: Li 35c--,70 Authorized signature: /
J �i ./ — This permit application expires if a permi is not obtained
within 180 days after it has been accepted as complete.
Print name: Kevin Saxton Date: March 27, 2012 ■ Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \SIT- PermitApp.doc 10/01 19 440 4613T(II /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: 500 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) 50 cu. yds.
Retaining structure? (Check one) ® Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 4000 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 3 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-1 Occupancy 3 $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 03/03/2011 2
1 e ° Building Division
Development Code Provision Review
TIGARD Commercial Projects with Approved Land Use
Building Permit No.: S- TZO I)- -rmaii
Land Use Casefile No.: , SD P MP- - o000 3
Routed Plans:
Submittal Date: .43/
Submittal Date:
Submittal Date:
To the Applicant: ,
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies
to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the
notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed
above each section.
STAFF: please only mark those items on the left side that are approved.
Planning Review (contact 1 at 503 - 718 -), or or 4 @tigard- or.gov)
❑ Land Use Approval
❑ Building Plans Match Approved Plan: Yes ❑ No ❑
❑ Maximum Building Height
❑ Conditions Met
Notes: s
_f #
WOMPITITAVIIIIIMPliWZIFArf
/ / _
Original Plan: Approved ❑ Not Approved Date: / 2-4
NC) Revision 1: Approved E Not Approved ❑ Date: O _ 1
Revision 2: Approved ❑ Not Approved ❑ Date: / 1 �'
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
J2PFI Permit #
❑ Conditions Met
Notes:
r
Original Plan: Approved, Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
r ! -
City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov)
❑ Street Trees
N❑otesrotected Trees o / �� 1
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Perm) Coordinator Review (contact Albert Shields at 503 - 718 -242 ,1 r albert @ tigard - or.gov)
Planning Okay -to Issue Permit Arborist Okay to Issue .Permit
❑ Engineering Okay to Issue Permit
Notes: /' r
?'Z -a '' .� •
� �i /cam � 3Z -8' �
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant ,
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes No ❑
Date Routed'to Building:
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Page 2 of 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11455 SW SUMMERFIELD DR, TIGARD, OR,
97224
Commercial - Site Work
499 Final inspection
03/05/2013 00:00
SIT2012-00004
PASS - No C of O
Violation Summary:
Inspector Contractor
.)Tao l a - Ori - c76 4 f-
U U
Dan Nelson
From: Albert Shields
Sent: Monday, June 11, 2012 4:12 PM
To: Dan Nelson; Debbie Adamski
Cc: Dianna Howse
Subject: Schwindt Medical /Dental SDR2011- 00003, BUP2012- 00060, etc.
Planning & Engineering are OK with issuance of the building permits on this project, BUP2012- 00060, SIT2012- 00004,
PLM2012- 00112, etc. The Tree Mitigation Fee and Cash Assurance Conditions of the SDR have now been Met although a
glitch with Accela is preventing us from showing them as "Met." I've put an OK note in the SDR.
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PF12012 -00013 has been issued (although it was issued against the old address, 11445 and is not linked to
"Schwindt." Can we fix that ?)
You can release the Holds you put on the BUP, PLM, and SIT and issue those permits.
DISCLAIMER: E -mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
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