Permit u CITY OF TIGARD SITE WORK PERMIT
114- 2 ' • COMMUNITY DEVELOPMENT Permit #: SIT2013 00007
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2013
Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision: RTH TIGARDVILLE ADDITION, AMENC Lot: 52
Project Description: Site work for new community center
Contractor: R & H CONSTRUCTION CO Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
1530 SW TAYLOR ST 9905 SW MCKENZIE ST
PORTLAND, OR 97205 -1819 TIGARD, OR 97223
PHONE: 503 - 228 -7177 PHONE:
FAX: 503 - 224 -3638
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 07/03/2013 $2,829.92
Plan Review 07/03/2013 $1,839.45
Type of Use: COM 12% State Surcharge - Building 07/03/2013 $339.59
Class of Work: NEW Plan Review - Fire Life Safety 03/25/2013 $1,131.97
Project Valuation: $550,000.00 Info Process /Archiving - Lg $2.00 (over 07/03/2013 $22.00
11x17)
Erosion Control w /Permit - Ping 07/03/2013 $525.00
Site Specifics:
Excavation Volume: 690 cu. yd.
Fill Volume: 5060 cu. yd.
Impervious Surface: 29000 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:
Total $6,687.93
Required Items and Reports (Conditions)
1 Ersn Cntrl 503 - 639 -4175
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. ' - on . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di •ct questions to OUNk Ili;,;• 03.232.1987 or 1.800.332.2344.
Is • ued By: / / Permittee Sign: 411111111 4 /
Call 503.639.4175 by 7:00 a.m. for the next available i section 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 RECEIVED Site Work FOR OFFICE USE ONLY
Ci of Tigard MAR 2 5 2013 Received
`J g DateB : _ Permit No.: 6, ,,./ _ Oar
e 13125 SW Hall Blvd., Tigard, OR 97223 OF Plan Review
' a Phone: 503.718.2439 Fax: 503.598.19�(J'IT 1 V OF TIGARD Date/B : � �I� 3 Other Permit: al P p� Ot
T 1 GARD Inspection Line: 503.639 BUILDING DIVISION Date Ready/By: 1un� 6 El See Page 2 for
Internet: www.tigard or.gov 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 -Q
® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the r
CATEGORY OF CONSTRUCTION work indicated on this application
ID 1- and 2- family dwelling ® Commercial /industrial Valuation: $ 7i
CP
1:1 Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: C
Job site address: 9 ce �`" McKenzie Street /2, sa aQ IL New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet d
Suite/bldg. /apt. no.: Project name: St. Anthony Community Cen Covered porch area: square feet E
Cross street/directions to job site: SW Grant Ave. and SW Johnson St. Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 2S1OD Permit fees* are based on the value of the work performed.
Tax map /parcel no.: T2S 1W 2BD TL 100 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.
Site work for new Community Center. Valuation: $550,000
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: St. Anthony in Tigard Catholic Church & School Type of construction:
Address: 9905 SW McKenzie Street Occupancy groups:
City /State /ZIP: Tigard, OR 97223 Existing:
Phone: (503)639 -4179 Fax: (503)624 -2364 New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Ankrom Moisan Architects All contractors and subcontractors are required to be
Contact name: Drew Rocker licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6720 SW Macadam Ave., Suite 100 jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97219 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 245 -7100 Fax: : (503) 245-7710
E -mail: drewr @amaa.com
CONTRACTOR
Business name: R &H Construction BUILDING PERMIT FEES*
Address: 1530 SW Taylor St. (Please refer to fee schedule
City /State /ZIP: Portland, OR 97219 Structural plan review fee (or deposit):
Phone: (503) 228 -7177 Fax: (503) 224 -3638 FLS plan review fee (if applicable):
CCB lic.: 38304 Total fees due upon application:
Amount received: #9? ,597
Authorized signat e: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: re Rocker �----- Date: 3 -21 -13 * 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)
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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: 690 cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) 4,370 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density) 5,060 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 29,000 net 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 - 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 05/25/2012 2
Site Work Permit Application
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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 labcicd 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 05/25/2012 3
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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.
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1:\Building \Permits \SIT - PermitApp.doc 05/25/2012 4
o B uilding Division
Development Code Provision Review
TI c ( ° Commercial Projects with Approved Land Use
NietJ /-n /Le 5 42 S. a29-,,Jr
Building Permit No.: S(T c)0/3 000
Land Use Cascfile No.: ' CJ P 2OO d - Dl7OOlo
Routed Plans: • l • -
Submittal Date: 3 ,P- ((3
Submittal Date: ;i 7 / 3 , �e
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 le side that are approved.
Planning Review (contact At [ at 503 -718- L I-(S or @tigard - or.gov)
, �° / Land Use Approval
,Id Building Plans Match Approved Plap: Yes.. ..Er No ❑
)2e Building Height 35 h , 2 �
2 7�ov0. c
0.
Er Conditions Met
a Street Trees
ELI Protected Trees
Notes: nie tvN : ,/ 6 7 /5'" 1.41 d��lJn Z 002 DDOO (,p
'E Utse L - 1 �l fl-a► • w : , ,u,,, c!,, . . Fcn."s1 .M-n s $i - _ :. 5'
eve s6( vo&x+.46 . '441444c) p 1-.2..t J ,sottl et kit r r 12 -'0 74 - , c 6e .
rib 1✓ s 7/G1 / Q 144se +E./k ' /, 4 S ' o/ s7ieit`r
Po 1;4 £ ers-4( , /pk rm 'L1 Z(c (diode_ ""4 '. ZC'C 4 a,.
Original Plan: Approved ❑ Approved A Date: 3 -
Revision 1: Approved ®� Not Approved ❑ Date: S - 1-13
Revision 2: Approved Not Approved ❑ Date: r /
(Review Continues on Page 2)
Page 1 of 2
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
.0' Actual Slope: 1 i %
B- Permit # P Ft
❑ Conditions Met
Notes: N -� f F ( Ta„2.4._ \ / A-)
, ' V 5-e- D i 2 era e_ �j 2r i Nc.� 5� • n-g4
2A- u 3 b en_ ii 3 q- Ago)
Original Plan: Approved ❑ Not Approved,) Date: 4 8 / 1 3
Revision 1: Approved ❑ Not Approved ,Er Date: S LO 0
Revision 2: Approved Not Approved ❑ Date: ( 3 1 1 3
Qom, , s - to e 4_15 S fi W JFI T FOP- c "XaN a...Tl.■■
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
❑ Engineerin Okay to Issue Permit
Notes: e°�.ua / 3/4 A ✓f'
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
l }3
Okay to Issue Permit: Yes �� •1/6// 3 No �
Date Routed to Building:
3
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Page 2 of 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12520 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Site Work
499 Final inspection
PASS - No C of O
SIT2013-00007
Chip Barnett
Violation Summary:
Inspector Contractor