Permit CITY OF TIGARD SITE WORK PERMIT
�. COMMUNITY DEVELOPMENT Permit#: SIT2014-00009
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2014
Parcel: 2S113AB00700
Jurisdiction: Tigard
Site address: 16255 SW UPPER BOONES FERRY RD
Project: The Circuit Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Site work for TI: Patching pavement,restriping parking lot,new access,and erosion control.
Contractor: FIVE STAR BUILDERS INC Owner: COLEMAN BOULDERING LLC
PO BOX 555 ATTN:ANDY COLEMAN
BANKS, OR 97106 16255 SW UPPER BOONES FERRY RD
TIGARD,OR 97224
PHONE: 503-324-5220 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/13/2014 $524 30
Plan Review 04/16/2014 $340.80
Type of Use: COM 12%State Surcharge-Building 05/13/2014 $62.92
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 05/13/2014 $4.00
11x17)
Project Valuation: $48,000.00 Erosion Control w/Permit-Eng 05/13/2014 $100.00
Site Specifics:
Excavation Volume: 256 cu.yd.
Fill Volume: 460 cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking: Yes
Fence:
Total $1,032.02
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_ • or 1.800
Issued By: ••- Signature:
-
Call . .. . 175 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.
Pr-
Building Permit Atmlicati!.ECEIVEP
Site Work 1 ,}1. ,.1 I I I l I N i i \l
Si
City of Tigard
APR 16 2014 Received
13125 SW Hall lvd.,Ti OR DateB ` �. • Vii!'
Plan Phone: 503.718.2439 Fax: 503. idw, '^ ' tan ....422),
Inspection e ig�az3d-6o�gov75 BUILDING DIVISION ,Ready/By: Z� y �i• a for
TYPE OF WORK REQUIRED DATA:I-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/repiac ement ❑Other: equipment,materials,labor,overhead,and the profit for the
_
. CATEGORY OF CONSTRUCTION work indicated on this application.
•El 1-and 2-family dwelling Commercial/industrial
Valuation: S
❑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: /62.5 61,4 uppu2422246, rE ggy- 17_ 7 New dwelling area: square feet
City/State/ZIP:_i-1(1Ad211)1 OIL ( 73 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project m
nae C!-r-,.. Covered porch area square feet he
Cross street/directions to job site: S1,4 J,iz-A jkM 1Z-.0A7 Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIALAHR CHECKLIST
Subdivision: I Lot no.: Permit fees'are based on the value of the work performed.
2_5113 6• (90-7 OD
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: T117 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
PA-r(A-1 pkw_meI T, R -sT124f'E• fog (IA)pA ihll-i Valuation: $ 43 000
CaExisting building area:2 square feet
.11aT, NF_(-1 }�-L4zh ��,Nkb t' 1�PLl�c , //
; osi DN. CoN`leol, New building arcs:2.44../650 square feet
KnorRRTY OWNER I ❑ TENANT Number of stories:
Name: -( COL ►yAN Type of construction: v e,
Address: 605o 4-G 4-J Tl„AbA'•1 A\ Occupancy f :
City/State/ZIP:-pP �,{,a) ,gip -7 2.3 9 Existing: M it S- '
Phone:(5,3) $�`- 4: 'w/",_ Fax:( ) New: A_3
APPLICANT (] CONTACT PERSON
NOTICE
Business name: S 14N (-1E _ AJii Cf All contractors and subcontractors are required to be
Contact name: C 47t f ( Fis t= licensed with the Oregon Construction Contractors Board
i under ORS 701 and may be required to be licensed in the
Address: 9 390 %4 You 1(1 Flu_ jurisdiction in which work is being performed.If the
City/State/ZIP: n ,MINtJV 11 c F, 437/2i3 Yet is exempt from licensing,the following reasons
Phone:(503) 1-99 --7 73 7 Fax: :( )
E-mail: e r e.elie rc3-i V 1,con7
CONTRACTOR
Business name: Ff\. sr- 1:30 ti7e 1 (N C. BUILDING naMrr FRCP
Address: PO. 130K g5-5- Mime refanklire WSW*
City/State/ZIP: g,),,*,1 4 op___ -7 I0� Structural plan review fee(or deposit):
Phone:(519 '324- 720 Fax:(5L3) 32,1-0S55
FLS plan review fee(if applicable):
CCB lic.:
73 29 46 Total fees due upon application: f 3Yo.
Amount received:
Authorized signature: )17/-9 -,/ This permit application expires it a permit is not obtained
witbi'180 days after it has been accepted as complete.
I Print name:ST f 1`1-1 J 6.E.47-6E1e--. I Date:11/6/20 lI • Fee methodology set by Tri-County Building Industry
Service Board.
1:1Building\Permits\SIT-PermitApp.doc 10/01/09 440-4613T(I1/02/COM/WES)
Mr—
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: 2.5 t0 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 42 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 4490 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*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-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 add itional$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$1,000.00 or
fraction thereof.
1:1 Building\Permits\SFT-PermitApp.doc 05/25/2012 2
MK—
Building Permit Number: (51-7-0o 1 le- l_5 7
114 Building Permit Review
Commercial Projects with Approved Land Use
TIGARD
Site Address: /67 5--.5- t764) Ll4�� eVeMieS / ,-
❑Verify site address is valid.
Project Name : /Ae c,if-c_u,71-
Plapning Review
EP'Land Use Case Number: Raw ,v00 y p
Plans Match Approved Land Use:
❑ Site Plan [ 1landscape Plan(N 1 Pk)
®Urban Forestry Plan(NI Pr 1 l►' ievation PlakN P.)
E'fuilding Height: Maximum Height 4( , Actual Height N I k
Conditions Met: E'prior to Permit Submittal ❑ Prior to Permit Issuance
Approved by: Date:
Notes: COM,alk l$ nD}- mei+-, Do fli* $SSUQJ
/ /-it ` / � K -- G t � ' 411 _
o-r. M/`w i-cl ! 3 -e o '-/o S `,,.,p v , d K 134,5 c%»r_-L 5
Revisions (after Building Submittal only) Revie r a
Revision 1 Approved'' Not Approved ❑ � u 5--/-4y
Revision 2 Approve 0 Not Approved ❑
PP PP
Revision 3 Approved ❑ Not Approved ❑
Building Permit Submittal
Original Plan Submittal: Date: V4,Air By: d.3-7
Site Plans: #
Building Plans: # ,(//4-
Create Case Record#: U.-niter case# above for Building Permit Number.
Workflow Routing: nning O'rngineering unit Coordinator a ding
Workflow Sign-off: ❑ Sign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: R ingineering: (1) copy of permit application, (1) site plan, (1) building plan and
9ziOnal plan review routing form.
Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: Date:
Notes:
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_123013.docx
k
Engineering Review— reviewed by: _
❑ Actual Slope:
❑ PFI Permit#
❑ Conditions Met
Notes: •v ' A te.„4"4". .e",--1/
C9y - a vim we c�
Approved by: Date:
Revisions (after Building Submittal only) wer Date
Revision 1 Approved El Not Approved , L /
Revision 2 Approved Not Approved ❑ • i �f��
Revision 3 Approved ❑ Not Approved ❑
Permit Coordinator Review
,'Conditions Met-Prior to Issuance of Building Permit
//Notes: J/�C �'�1.�-.� 1�ic"CA{p YYJ Gtr f5/ c.4`
Z /7-#7 3 -D d cJ mod `��..T v� Li-% �i d cl�✓Ii•
Revision Notice 1: Date Sent to Applicant: y Z 'S/ `J -:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Applica
i
Okay to Issue Permit- 74110 Date: ` T` /
l:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_123013.docx
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
16255 SW UPPER BOONES FERRY RD,
TIGARD, OR, 97224
Commercial - Site Work
499 Final inspection
PASS - No C of O
SIT2014-00009
Chip Barnett
Violation Summary:
Inspector Contractor