Permit •
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT 401;4140(
Permit#: SIT2013 00022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 2S104AD04501
Jurisdiction:
Site address: 12420 SW 127TH AVE
Project: Jack Park Subdivision: BELLWOOD Lot: 50
Project Description: Construction of 112'bridge,6'wide asphalt&concrete trails,and misc.site improvements. 11/18/13,reprinted to
add site address.
Contractor: GREEN THUMB LANDSCAOE&MAINTENANCE INC Owner: CITY OF TIGARD
PO BOX 5172 13125 SW HALL BLVD
SALEM,OR 97304 TIGARD,OR 9722313165
PHONE: 503-362-7327 PHONE: 503-639-4171
FAX: 503-364-6391
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/21/2013 $1,267.40 '
Plan Review 08/21/2013 $823.81
Type of Use: COM 12%State Surcharge-Building 08/21/2013 $152.09
Class of Work: ALT Info Process/Archiving-Sm$0.50(up to 08/21/2013 $76.00
11x17)
Project Valuation: $201,111.00 Erosion Control w/Permit-Eng 08/21/2013 $300.00
Site Specifics:
Excavation Volume: 460 cu.yd.
Fill Volume: 303 cu.yd.
Impervious Surface: 4800 sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: Yes
Fire Underground: No Accessible Parking:
Fence:
Total $2,619.30
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
Utili otification •-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or rect questions to 0 • ailing 503.232.1987 or 1.800.332.2344. -
Is ued By: k • b ji Permittee Signa re: r
Call 503.639.4175 by 7:00 a.m.for the next available inspe n 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.
CITY OF TIGARD SITE WORK PERMIT
n
II
- COMMUNITY DEVELOPMENT Permit#: SIT2013-00022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
TIGARD Parcel: 2S104AD04501
Jurisdiction:
Site address: NO ADDRESS
Project: Jack Park Subdivision: BELLWOOD Lot: 50
Project Description: Construction of 112'bridge,6'wide asphalt&concrete trails,and misc.site improvements.
Contractor: GREEN THUMB LANDSCAOE&MAINTENANCE INC Owner: CITY OF TIGARD
PO BOX 5172 13125 SW HALL BLVD
SALEM, OR 97304 TIGARD, OR 9722313165
PHONE: 503-362-7327 PHONE: 503-639-4171
FAX: 503-364-6391
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/21/2013 $1,267.40
Plan Review 08/21/2013 $823.81
Type of Use: COM 12%State Surcharge-Building 08/21/2013 $152.09
Class of Work: ALT Info Process/Archiving-Sm$0.50(up to 08/21/2013 $76.00
11x17)
Project Valuation: $201,111.00 Erosion Control w/Permit-Eng 08/21/2013 $300.00
Site Specifics:
Excavation Volume: 460 cu.yd.
Fill Volume: 303 cu.yd.
Impervious Surface: 4800 sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Stom Drains: Retaining Wall: Yes
Fire Underground: No Accessible Parking:
Fence:
Total $2,619.30
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ 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 77�� r1�/T FOR OFFICE USE ONLY
City of Tigard RECEIVED ED Date/B: 7 t� � ;� Permit No.:6,T�pr3—f�Q�xa1
V 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' Phone: 503.718.2439 Fax: 503.598.1481 2 4 2013 Date/B : �� � �� Other Permit:
I`tM��017,'DUDa
TIGARD. )
Inspection Line: 503.639.4175 . Date Ready/By: Jere ® See Page 2for
Internet: www.tigard-or.gov Notified/Method: S 7 /J Qr" Supplemental Information
CITY Ola TIGARD rtvtor , _ _
TYPE UL G DIVISION 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.
❑ 1-and 2-family dwelling ❑Commercial/industrial
Valuation: Sn/a
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ®Other: Park Impvmts Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:NA New dwelling area: square feet
City/State/ZIP:Tigard,OR.97223 Garage/carport area: square feet
Suite/bldg./apt.no.:n/a Project name:Jack Park Ph 1 Imprvmts Covered porch area: square feet
Cross street/directions to job site:Access to the project from trailheads: Deck area: square feet
I 27'h Avenue located at the east side of intersection of I27'h Ave and Bell Ct. Other structure area: square feet
South side of project from TVFR fire station on Walnut St(12617 SW Walnut St) REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:n/a Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S104AD 04501,d d" ?101-i APro 1-1�� 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.
Construction of 6'wide asphalt and concrete trails,concrete walls, curb, Valuation: $201,111.26
signage,installation of 112'long pony truss style glulam bridge,installation Existing building area: square feet
of 2 concrete abutments,excavation,embankment,fine grading,gravel trail New building area: square feet
- ® PROPERTY OWNER 0 TENANT Number of stories:
Name:City of Tigard Type of construction: Park Imprvmnts
Address: 13125 SW Hall Blvd Occupancy groups:
City/State/ZIP:Tigard,OR.97223 Existing:
Phone:(503)718-2466 Fax:( ) New:
® APPLICANT I ® CONTACT PERSON
NOTICE
Business name:City of Tigard All contractors and subcontractors are required to be
Contact name:Jeff Peck licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13125 SW Hall Blvd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR:97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)718-2466 Fax: :( )
E-mail:jeffp @tigard-or.gov .
CONTRACTOR
Business name:Green Thumb Landscaping&Maintenance,Inc. BUILDING PERMIT FEES*
Address:PO Box 5172 (Please refer to fee schedule
City/State/ZIP:Salem,OR.97304 Structural plan review fee(or deposit):
Phone:(503)362-7327 Fax:(503)364-6391 FLS plan review fee(if applicable):
CCB lie.: 131659 Total fees due upon application: _
Amount received:
Authorized signature: S li�� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Scott Friedma Date:7-24-13
t • * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Petinits\SIT-PennilApp.doc 10/01/09 440-46I3T(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: 460 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 21,460 sf cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) 303 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
® Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 4,800 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 S.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.
1:\Building\Permits\SIT-PermitApp.doc 05/25/2012 2
IISite Work Permit Application
Plan Submittal Requirements
T 1 G A R D 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\Pennits\SIT-PennitApp.doc 05/25/2012 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.
1:\Building\Permits\SIT-PermitApp.doc 05/25/2012 4
.,,-,-,---
, ,
1G 1s'_yI
1 ,t,,4.;,,,,,,A.4.4.,,:,_14 e Building Division • . • • ,.:---- .
Development Code Provision Review
TI eA R tj Commercial Projects - With Approved Land Use
Building Permit No.: . . ' ..l ao 13 -oo a a a
Land Use Case File No.: SLK )'41-t - 9•012,--coo ',%3 `1//la?Da-doh?--/
Project Name: ��i c.l,-,. PP,wZV--
Site Address: a,SI D 4-1Afb 04/5-01 cz, asla4 96-0'1 leco , Suite/Bldg #:
Plans Routed:
Original Plan Submittal Date: 7/ i 1/3 Routed By: .
15t Revision Submittal Date: Routed By:
2nd Revision Submittal Date: Routed By:
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 item on the left side that are approved. •
Planning Review(contact at (503) 718-2'/V0 or 4 l/ @tigard-
or.gov
Land Use Approval
❑ Building Plans Match Approved Plan: Yes ❑ No ❑
❑ ximum Building Height
M.! Conditions Met
❑„Street Trees �, �
I� Protected Trees /1'v
,
Notes: l/ ‘ /4 O 5L/2 d r00e6 4.01
44-i- / inat-
Original Plan: Approved ❑ Not Approved Date: g”/'. /
Revision 1: Approved Not Approved ❑ Date: 6— 5.—/3 \)) *
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
I:\CURPLN\Masters\Development Code Provision Review DCPR_COM_WithLandUse.doc Rev.01/16/13
Engineering Review(contact Mike White at(503) 718-2464 or MikeW @ tigard-or.gov)
❑ Actual Slope: VI lti f-i %
❑ PFI Permit#
❑ Conditions Met
Notes:
Original Plan: Approved zr Not Approved ❑ Date: 1 (3
Revision 1: Approved Er 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 1A No K / 7 3
Date Routed to Building:
V/3/////// —
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision Review\DCPR_COM_WithLandUse.doc Rev.01/16/13
CITY OF TIGARD RECEIVED
CAPITAL CONSTRUCTION AND TRANSPORTATION JUL 2 4
2013
Engineer's Estimate for: CITYOFTIGARD
BUILDING DIVISION
JACK PARK IMPROVEMENTS - PHASE 1 (SITE WORKS PERMIT COSTS)
CIP Park Project
Jack Park
Item
No Description Quantity Unit Unit Price Item Total
Schedule A
A
1 Erosion Control 1 Lump Sum $ 14,299.20 $ 14,299.20
2 Clearing and Grubbing 1 Lump Sum $ 48,811.64 $ 48,811.64
3 General Excavation 460 CY $ 31.93 $ 14,687.80
4 Fine Grading 21460 SF $ 0.09 $ 1,931.40
5 MHMAC Level 2, 1/2-Inch Dense Trail, 1400 SF $ 8.41 $ 11,774.00
Including Aggregate Base and Shoulder
6 1/4"-0 Gravel Paving 680 SF $ 9.44 $ 6,419.20
7 Concrete Pavement,Including Aggregate Base 3715 SF $ 5.29 $ 19,652.35
and Shoulder
8 Structural Concrete Seat Wall at Playground 65 LF $ 329.88 $ 21,442.20
Structural Concrete Bridge Abutments including 1 Lump Sum $ 32,061.37 $ 32,061.37
Concrete Wing Walls
10 Timber Bridge Assembly and Erection 1 Lump Sum $ 26,860.61 $ 26,860.61
11 Chain Link Fence Guardrail 36 LF $ 72.84 $ 2,622.24
12 Longitudinal Pavement Markings-Paint 1 Lump Sum $ 549.25 $ 549.25
............................................................................................... ........... ................ ............
Project Total $ 201,111.26
I:\ENG\I -Active Projects\92022 Jack Park\Permits\COT Bldg Department\Jack Park-Site Works Permit Costs.xlsx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12420 SW 127TH AVE, TIGARD, OR, 97223 2013 - 11 - 26 15:07:00
Record Type: Record ID:
Commercial - Site Work SIT2013 - 00022
Inspection Type: Result:
299 Final inspection PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor