Loading...
Permit CITY OF TIGARD SITE WORK PERMIT I 1 COMMUNITY DEVELOPMENT Permit #: SIT2012 -00018 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/01/2012 TIGARD 9 Parcel: 2S101AB03000 Jurisdiction: TIGARD Site address: 12035 SW 70TH AVE Project: Red Rock Subdivision: 2012 -009 PARTITION PLAT Lot: 2 Project Description: Site grading and retaining walls 5000 cubic yards Contractor: BRIAN CLOPTON EXCAVATION INC Owner: RED ROCK BUSINESS ASSOCIATES LLC P 0 BOX 509 23077 SW NEWLAND RD WILSONVILLE, OR 97070 WILSONVILLE, OR 97070 PHONE: 503 - 682 -0420 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee - Site Work 10/01/2012 $379.22 Plan Review 09/06/2012 $246.49 Type of Use: COM 12% State Surcharge - Building 10/01/2012 $45.51 Class of Work: NEW Erosion Control w /Permit - Ping 10/01/2012 $100.00 J Info Process /Archiving - Lg $2.00 (over 10/01/2012 $6.00 Project Valuation: $30,000.00 11x17) Site Specifics: Excavation Volume: cu. yd. Fill Volume: 6000 cu. yd. Impervious Surface: sq. ft. Engineered Fill: Soil Report Required: Paving: No Grading: Yes Landscaping: Site Prep: Yes Storn Drains: No Retaining Wall: Yes Fire Underground: No Accessible Parking: No Fence: Total $777.22 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 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 N • cation Cent- Tho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir t questions to OUNC elfin. • 0.232.1987 or 1.800.332.2344. Iss ed By: , /` 1 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 RECEIVED FOR OFFICE USE ONLY . City of Tigard �! Received 6 ` ` r / �- Permit No 5 ° 13125 SW Hall Blvd., Tigard, OR 97223 SEP U 6 2012 Date /By: ��°� V(���0 g Plan Review oI e n,l C Phone: 503.718.2439 Fax: 503.598.1960 Date /By: t I l C I OtherPermit:OQ /O - 0o�� T I G A R D Inspection Line: 503.639.4175 CITYOFTIGARD Date Ready /By: ba Juris: ® See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified /Method: / 1• 1 Supplemental Information UM 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. E] I- 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: / 2. V ?j,- 5 u) 7 New dwelling area: square feet City/State /ZIP: 7 , 7 ,,,, J B r ■ e Garage /carport area: square feet Suite/bldg. /apt. no.: l r Project name: £w 4 c _ Covered porch area: square feet Cross street/directions to job site: 5 v 7 Z ': / f y wr( --_ Deck area: square feet �� , .6 /mo if l ,.p p, Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: 1 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. D 5j to gI, AGCc. /'� a(vI 6(,4�C�S Valuation: $ 39 5 -- 0 - 0 - 0 c„.„6„... CA.! QS [ Existing building area: square feet {{{ Jc New building area: square feet r= PROPERTY OWNER ❑ TENANT Number of stories: Name: /2,e at 1`'9 c_(C_ c rit c f y‘.e 9 f a 44 4 5 LC C-- Type of construction: Address: 2 - 5 0 1 1 S co , Z c 4 0 _ i ce,. Occupancy groups: City/State /ZIP: t /1 f p.m ✓i ff.,. ay. 9 7 6 7 6 Existing: Phone: ( 3S 7 -13 7 Fax: ( ) New: g.APPLICANT Ek CONTACT PERSON NOTICE Business name: 154,-i . <� f c l_ 6 . 1 „. 1 ', vi 0 ,7f 7Z /l ' _ V All contractors and subcontractors are required to be Contact name: �l , r^ D _ licensed with the Oregon Construction Contractors Board 1 r 1 � K' t: under ORS 701 and may be required to be licensed in the Address: / t7U �o 1 Z / jurisdiction in which work is being performed. If the City/State /ZIP: O �„- o'( �, �' a > 1 t, applicant is exempt from licensing, the following reasons apply: Phone: (7 - �r�, � 7)) / f o — Cf f VU Fax:: () a;) 5-9r-0/ v, E -mail: 5 4 f Q / c _ °e co vv.- C125'f • /D_ CONTRACTOR Business name: Sr �� cr Ali va- c Q ' ) r/-`, - BUILDING PERMIT FEES* Address: Q 5 ,?c S-- O (Please refer to fee schedule) City/State /ZIP: (,,J I ' (5 cry, V I lie zy _ 1 - 707 0 Structural plan review fee (or deposit): / ) ( S 3 &SZ -16 FLS plan review fee (if applicable): ( 5a3 ) ( Phone: � 2 � O L� Fax: o CJ CCB lic.: 5 3 3 y/I I( Total fees due upon ap Amount received: �L4.�p, O Authorized signature: This p ermit application expires if a permit is not obtained d L q ���/// ? ' within 180 days after it has been accepted as complete. Print name: i 3 It, P� } — .- / C.-1t / L� Date: // /� * Fee methodology set by Tri- County Building Industry '` Service Board. I:\ Building\Permits \SIT - PermitApp.doc 10 /01/09 440- 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: — 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 g Other: f �„ 4 (.pp/ *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 ❑ Fire Line *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 - 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. (:\Building \Permits \SIT - PermitApp.doc 05/25/2012 2 j prolluilding Permit Application Site Work FOR OFFICE USE ONLY City of Tigard Received Date/By: Permit No.: ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: Ti G A P. D Inspection Line: 503.639.4175 Date Ready/By: rung: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New constructio ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rowded to the nearest dollar) of all ❑ Addition/alteration/r ilacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. El 1- and 2- family dwelling El Commercial /industrial Valuation: $ ❑ Accessory building El Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE FORMATION AND LOCATION Total number of floors: Job site address: New dwelling area: square feet City/State /ZIP: Garage /carport area: square feet Suite/bldg. /apt. no.: Proje 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: I Lot no : Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WOR work indicated on this application. Valuation: $ Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ T NA ' Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT ❑ C'I NTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: censed with the Oregon Construction Contractors Board u er ORS 701 and may be required to be licensed in the Address: jury diction in which work is being performed. If the City /State /ZIP: app 'cant is exempt from licensing, the following reasons appl : Phone: ( ) Fax:: ( ) E -mail: CONTRACTOR Business name: BUILDING PERMIT FEES* Address: (Please refer to fee schedule) Structural plan review fee (or deposit): City /State /ZIP: FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB lic.: Total fees due upon application: 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: Date: * 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) • r - r III _ a Building Division Development Code Provision Review T 1 G A R D Commercial Projects with Approved Land Use Building Permit No.: ' -< < a I a - ' DOD I g Land Use Casefile No.: P 0 e- a 0- 0000 Routed Plans: Q /� i Y Submittal Date: 1 / 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 it - on the L r eft de that are ap i roved. . L'fi - .l a 2. ' Planning Review (contact ii, _ at 503 -718- ..r 0 or ?"-p. ArOf @tigard- or.gov) v Land Use Approval —/ E "Building Plans Match Approved Pl : Yes LEI No ❑ ❑ Maximum Building Height Approved a-Conditions Met Notes: Original Plan: Approved er Not Approved ❑ Date: 9' 012-- Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) r Actual Slope: Vacs, ❑ PFI Permit # ❑ Conditions Met Notes: Original Plan: ApprovedM Not Approved ❑ Date: 9 6 Ell L Revision 1: Approved ❑ Not Approved ❑ Date: J Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @ tigard - or.gov) ❑ Street Trees ❑ Protected Trecs Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) ❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit ❑ Engineering Okay to Issue Permit Notes: 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: , Page 2 of 2 JAN -24 -2012 TUE 11:54 AM BONES CONSTRUCTION FAX NO. 5036491717 P. 02 S 1T2o 12- 000 I $ CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR UNDERGROUND PIPING Procedure Upon completion of work, Inspection and tests shall be made by contractors representative and witnessed by an owners representative. All defects shall be corrected and system left in service before contractor's personnel finally leave jab. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood the owners representative's signature In no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE � Red Rock Center 1f 0 PROPERTY ADDRESS 12023 SW 70'" A ACCEPTED BY APPROVING AUTHORITY('S) NAMES Tualatin Valley Water DIstrlct Engineering Section ADDRESS PLANS YES [71 NO INSTALLATION CONFORMS TO ACCEPTED PLANS EQUIPMENT USED IS APPROVED ® YES ❑ NO IF NO STATE DEVIATIONS: HAS THE 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 © YES ei NO BEEN LEFT ON THE PREMISES. IF NO, EXPLAIN SUPPLIES SLOGS. LOCATION "A', 'B', 'C' PIPE TYPES AND CLASS TYPE JOINT DI, and C -800 MJ, Elastlmeric PIPE CONFORMS TO NEPA 24 STANDARD CEI YES ❑ NO UNDERGROUND FITTINGS CONFORM TO N _ _ STANDARD ® YES ❑ NO PIPES IF NO, EXPLAIN • AND JOINTS JOINTS NEEDING ANCHORAGE CLAMPED, STRAPPED, OR BLOCKED IN [,a YES ® NO ACCORDANCE WITH NFPA 24 _ STANDARD IF NO, EXPLAIN, Secured with Field lock Gaskets, Locking MJ Retainer Glands FLusHulta 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 400 gpm (1514 Umin) for 4 -inch pipe, 600 gpm (2271 I /min) for 5- inch pipe, 900 gpm (2838 1 /min) for 6 -inch pipe, 1600 gpm (3785 1 /min) for 8 -inch pipe, 2440 gpm (5678 l/min) for 10 -inch pipe, and 3520 gpm (7570 I /min) for 12 -Inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above DESCRIPTION static pressure in excess of 150 psi (10.3 bars) for two hours. ),EAKAGE: 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 i/h) 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 fl oz Per in, valve diameter per hour (3o 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/min leakage Is permitted for each hydrant. NEW UNDERGROUND PIPING FLUSHED ACCORDING TO NFPA 24 STANDARD ® YES Q NO BY (COMPANY) Bones C❑nstruclon Co. IF NO, EXPLAIN HOW FLUSHING FLOW WAS OBTAINED THROUGH WHAT TYPE OPENING FLUSHING ® PUBLIC MAIN ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ HYDRANT BUTT ® OPEN PIPE TESTS - LEAD -INS FLUSHED ACCORDING TO STANDARD ❑ YES ❑ NO BY: (COMPANY) IF NO, EXPLAIN HOW FLUSHING FLOW WAS OBTAINED THROUGH WHAT TYPE OPENING ❑ PUBLIC MAIN ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ Y CONN TO FLANGE & SPIGOT LI OPEN PIPE JAN -24 -2012 TUE 11:54 AM BONES CONSTRUCTION FAX NO. 5036491717 P. 03 HYDROSTATIC ALL NEW UNDERGROUND PIPING HYDROSTATICALLY TESTED AT TESTS 200 PSI FOR 7 _ HOURS TOTAL AMOUNT OF LEAKAGE MEASURED LEAKAGE 0.0 GALS. OVER L HOURS TEST ALLOWABLE LEAKAGE GALS. OVER HOURS ~ NUMBER INSTALLED TYPE AND MAKE ALL OPERATE SATISFACTORILY HYDRANTS 1 Mueller ® YES ❑ NO WATER CONTROL VALVES LEFT WMDE OPEN E] YES ® NO CONTROL IF NO, STATE REASON FIre Sprinkler Installer still to connect VALVES HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH THOSE OF FIRE DEPARTMENT ANSWERING ALARM YES ❑ NO DAT LEFT IN SERVICE REMARKS . Fire Sprinkler Installer still to connect NAME OF INSTALLING CONTRACTOR Bones Construction Co. TESTS WITNESSED BY SIGNATURES FOR PROP, RTY OWNER ( G ED) ITLE DATE FOR I : ` - ; ^ ; % 1 TITLE Tester DATE 1/24/2012 ADDITIONAL EXPLANATIONS AND NOTES • • JAN -24 -2012 TUE 11:54 AM BONES CONSTRUCTION FAX NO. 5036491717 P. 01 D/Z 000/8 � Bones Construction Inc. W GENERAL CONTRACTOR caw 00734 General Contractor • 3508 S.W. 204th • Aloha, Oregon 97007 -1028 • (503) 644 -5682 • Fax (503) 649 -1717 FAX TRANSMITTAL COVER SHEET DATE: _ - a. z ATTN• i 1 ii: s°3 • f/' Z 440 348 COMPANY: 6 crri Iv P 8 II 1 v• Number of pages sent including cover sheet: 1 Subject: Zdinek &4c,r ► 1 ( er1'. Comments: 3 - 380 I. b S 6 dgi Ad 4. ws• t FROM: Tr. S CD . _ • CC: If you do not receive all of the pages, please call as soon as possible. Thank You!