Permit CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2013-00019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2013
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10330 SW GREENBURG RD
Project: Red Lobster Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Repair or replace handicap parking and restripe.
Contractor: HALEY CONSTRUCTION INC Owner: LINCOLN CENTER LLC
900 ORANGE AVE BY SHORENSTEIN PROPERTIES LLC
DAYTONA BEACH, FL 32114 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 386-944-0470 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 09/05/2013 $674.92
Plan Review 09/05/2013 $438.70
Type of Use: COM 12%State Surcharge-Building 09/05/2013 $80.99
Class of Work: ALT Erosion Control w/Permit-Eng 09/05/2013 $150.00
Project Valuation: $75,000.00
Site Specifics:
Excavation Volume: 20 cu.yd.
Fill Volume: 10 cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Yes Site Prep: Yes
Storn Drains: Yes Retaining Wall:
Fire Underground: Accessible Parking: Yes
Fence:
Total $1,344.61
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 Notifica '•• 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 •.estions to •• C by calling 503.232.1987 or 1.800.332.2344.
Issued By: ( Permittee Signat I re:
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.
Jul, 23 13 07: 42a S Hale 707426905242 p. 3
BuddinE Permit AppGcati •
Site Work RECEIVED FOR OFFICE i: f, ONLY
City of Tigard �IUL 2 3 2013 Received
_7 A3� J- Permit No.: i-A0/6-.oo0v9
IN
d • 13125 SW Ilan Blvd.,Tigard,OR 9722 Plan Review �j O
•
Phone: 503.718.2439 Fax 503-59/effit IGARD Date/E . /;I�,
Other Permit.� �O�JF'���J
- inspection line: 503.639.4175 �I'T F I Date Ready=y: Jars: 2 See Page 2 for
T l i:A R D p Internet: www.tigard-or.gov BUILDING DIVISION NotdficeMethod. 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.
Valuation: S
❑ 1-and 2-family dwelling ®Commercial/industrial -
Number of bedrooms: C.>
❑Accessory building , 0 Multi-family
CI Master of bathrooms:Muster builder ' ❑Other: --
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:10330 SW Crcenburg Road New dwelling arcs: square feet
..__-
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt_no.: Project name:Red Lobster Covered porch area: square feet
Cross street/directions to job site:Washington Square Road Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST M
Subdivision. Lot no.: Permit fees'are based on the value of the work performed. (l
Indicate the value(rounded to the nearest dollar)of all VV
Tax map/parcel no-: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application. yl`r
Rework site drainage around building,repair or replace handicap parking,re-str Valuation: SS75,000.00
Existing building area: 8,584 square feet IP%'
New building area: 8,338 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: l 11
Name:Red Lobster Type of construction: VB
Address:1000 Darden Center Drive Occupancy groups: 1-\
City/State/ZIP:Orlando,FL 32837 Existing: A2
Phone:(760)707-9124 Fax:(407)241-5825 New: A2 �(
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Red Lobster All contractors and subcontractors are required to be rk
licensed with the Oregon Construction Contractors Board
Contact name:Steve Hale
under ORS 701 and may be required to be licensed in the
Address:1048 Peppertree Drive jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Fairfield,CA 94533
apply:
Phone:(707)427-8671 Fax::(707)426-9052
E-mail:
CONTRACTOR
Business name:Haley Constriction BUILDING PERMIT FEES* c
Address:900 Orange Ave.
(Please refer to fee schedule)
Structural plan review fee(or deposit):
City/Strte/7.iP:Daytona Beady Fl.32114
- Fl.S plan review fee(if applicable):
Phone:(396)941-0478 , Fax:(386)944-0471 ' .k.
Totel fees due upon application:
CCB lie.:186613
Amount received:
Authorized signature: 34-1,4x t la� This permit application expires if a permit is nut obtained
within 180 days after it has been accepted as complete.
Print name:Steve Hale Date:7/23/13 • Fee methodology set by Tri-County Building Industry
Jul 23 13 07: 43a S Hale 707426905242 p. 4
._ .N "
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: _20 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 20 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 10 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other: None _
*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 S500.00 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 51.000 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
550,000.00.
$50,001.00 to$100,000.00 $540.42 for the first$50,000.00 and
$5.38 Inr each additional$1.000.00 or
• traction 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.
Q ° Building Division
Development Code Provision Review
T 1 G A R D Commercial Projects - With Approved Land Use
Building Permit No.: I i (22o 13 —000 ) 9-f
Land Use Case File No.: '►1'-i HO ao / 6- 0000
3
Project Name: s L.--e PDsT1.2-
Site Address: too a a>i- f,• 6 k-a LID , Suite/Bldg #:
Plans Routed:
Original Plan Submittal Date: 7 45//2) Routed By: (TK
1St 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 items on the left side that are approved.
Planning Review(contact at (503) 718- Vi 3 r( or 7417/2
/ @tigard-
or.gov)
8' Land Use Approval
12—Building Plans Match Approved Plan: Yes Er . No ❑
ia Maximum Building Height
❑ Conditions Met
O Street Trees
❑ Protected Trees
Notes: K'09-9,/77c - )2162 a S/7p(o/2m fr ACe4 7/162_,roleGI/d'4 Ve4/f7Eh 07)0/ofd
Ba72/S r.
fnnz&c-Te7J AF�T� l Lc.re)&-'' go viscc/(7-Z.Z./3) .LP} SG/ey6-Philvvs (Li"/�)
/iU fGJ,�,u S�" (L.Z. /Original Plan: Approved ❑ Not Approved 8 Date: 7- LY- J
Revision 1: Approved* Not Approved ❑ Date: 7 - 4-,3
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
1:\CURPLMMasters\Development Code Provision RevieNADCPR_COM_WithLandUse.doc Rev.01/16/13
Engineering Review(contact Mike White at(503)718-2464 or MikeW @tigard-or.gov)
❑ Actual Slope: V
❑ PFI Permit#
❑ Conditions Met
Notes:
Original Plan: Approved.0r Not Approved ❑ Date: . 2
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: /
, ' i / 1` C.,(,*'
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to A 'cant
Okay to Issue Permit: Yes No 4( 7/3/i 1
Date Routed to Building• �J_,
Page 2 of 2
I:\CURPLN\Masters\Development Code Provision RevieWJtDCPR_COM_WithLandUse.doc Rev.01/16/13
Jul 23 13 07: 42a S Hale 707426905242 p. 1
•
STEVE HAL
FACSIlVIII.YE TRANSMITTAL
CONSULTING/MANAGEMENT RECEIVED
1048 Peppertree Drive JUL 2 3 2 013
Fairfield,CA 94533
Fax:j0j 42761-9052 CITY OF TIGARD
BUILDING DIVISION
Company: City of Tigard Date: 7/23/13
Deliver to: Debbie Adamski Fax Number: 503-598-1960
From: Steve Hale Number of pages,
Including cover sheet: 4
Project: Red Lobster remodel
Tigard, OR Original to Follow by Mail: No
Job No.:
Remarks:
Debbie-attached are the applications for Site Work and
Mechanical as requested.
Let me know if you need anything else or if have any questions.
Thanks, Steve Hale
C.\U&erev^oeveDocumefl 111111\nardenlaaeForms0ecneckRea ax152CheckReaue
..I ..AM
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10330 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Site Work
499 Final inspection
2013-12-10 (null)
SIT2013-00019
PASS - No C of O
Violation Summary:
Inspector Contractor