Permit p CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2014-00011
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/12/2014
Parcel: 2S102AD01900
Jurisdiction: Tigard
Site address: 8935 SW BURNHAM ST
Project: TVF&R Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Site work associated with addition,seismic upgrade&renovation
Contractor: EMERICK CONSTRUCTION CO Owner: TUALATIN VALLEY FIRE&RESCUE
P.O. BOX 66100 11945 SW 70TH AVE
PORTLAND,OR 97290 TIGARD,OR 97223
PHONE: 503-777-5531 PHONE: 503-259-1188
FAX: 503-771-2933
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 06/12/2014 $524.30
Plan Review 05/01/2014 $340.80
Type of Use: COM 12%State Surcharge-Building 06/12/2014 $62.92
Class of Work: ALT Erosion Control w/Permit-Eng 06/12/2014 $100.00
Project Valuation: $47,288.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 996 sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: No
Landscaping: Yes Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $1,028.02
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 estions UNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: ill y Permittee Signature: !�,jl(1/�,
- � 111 -""�"
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.
•
' . Etnadang Permit Application
• Site Work RECEIVFJ
FOR OFFICE USE ONLY
Ihii City of Tigard Received Permit No.: ,r '[ )
• 13125 SW Hall Blvd.,Tigard,OR 97223 4 PR 3 0 2014 Pleas Revi
g Phone: 503.718.2439 Fax: 503.598.19 DateB : /e►I►�jL ZagiEl Other Permit:
1.1 6 A I,1 Inspection Line: 503.639.4175 CITY OF IIGARU Date Ready :y: June ® See Page 2 for
Internet: www.tigard-or.gov gUILDIN(rpirminp, Notified/Method:Co i i-ii Supplemental Information
'`F4'': TYPE OF WORK REQUIRED DATA:-I•AND 2-FAMILY DWELLING
❑New construction El 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. r-{
❑ 1-and 2-family dwelling VCommercial/mdustrial Valuation: S rb
El Accessory building ❑Multi-family Number of bedrooms:
kl
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: ``
Job site address: Al2�- ../ &,04.041.--0( Gjr" New dwelling area: square feet
City/State/ZIP: 776.--Agp, t7f2___ 172/z Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: riz. T�•I Covered porch area square feet
Cross street/directions to job site: /a42".1144/%4 ;
/, �4 Deck area: square feet
Other structure area: square feet
REQMICEDDATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: -Permit fees*are based on the value of the work performed.
Indicate the value(rotnded to the nearest dollar)of all ���r 1111"
Tax map/parcel no.: equipment,materials,labor,overhead, d the rof ►e
DESCRIPTION OF WORK work indicated on this application2 7°
Vpuil Sit�''llL I _"(Ti1OF7 f . / Valuation: $ j, �`
o AVP(TL�..( ��M�/`�`��-( Existing building area Gf 7Zof square feet
.
New building area: /116 square feet
PROPERTY OWNER I 0 TENANT Number of stories: /
Name: - /q u/ VA " nee, 7 t.). a- Type of construction: y y 7_ v
Address: //G -1 ! 7 'm AL/E. Occupancy groups: g, ip__',
.2.____
City/State/ZIP: ` 1 jk 4 ,pe__77Z2, Existing: .
Phone:(Lb3) js7.)o$ Fax:( ) New: Ii
(APPLICANT ❑ CONTACT PERSON l I
NOTICE
Business name: ri N gp¢y e �j All contractors and subcontractors are required to be
Contact name: 1� J licensed with the Oregon Construction Contractors Board r
under ORS 701 and may be required to be Itensed in the •p
Address:'774 dw 14-14/A/1/46 r - }() Z5i7 jurisdiction in which work is being performed.If the
City/State/ZIP: !�� �/7, pa_ 7
apply:
is exempt from licensing,the following reasons
pP l y •�
Phone:(e )2,7,-/- q66, Fax::( )
E-mail: /f3 1,1WI G° f7V I /,C 1 g
CONTRA I
Business name: (Ha,C k 6,,,,,,%4u C l7O 0 BUILDING PERMIT FEES*
Address: pc +� 4,4100 (Please refer to fee schedule)
City/State/ZIP: 2 7a S� Structural plan review fee(or deposit):
Pe T�.� X 02
Phone:( 5 3) 777- 55 3/ Fax:(60 3) 777 -9.933 FLS plan review fee(if applicable):
CCB lic.: 10-7 9., Total fees due upon application:
Amount received:
Authorized sr lure This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: /A j Date: So/001y • 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)
y w
I.
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
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Pennit 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 El *Parking(including ADA)and Lighting
compliance Plan
El Grading Plan and details ❑ *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report(if required)
❑ Retaining Structures El 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.
1:\Building\Permits\SIT-PermitApp.doc 05/25/2012 2
r 5,- »Ord, P€.,24?tr
Building Permit Number: T,,9O/ DUO/ I
114 Building Permit Review
Commercial Projects with Approved Land Use
I I( \Ru
Site Address: eA 35 sw Burt-thaw, St.
erify site address is valid.
Project Name : IV-F.2- Lb c,,,,
Planning Review
la---r-and Use Case Number: DDQ-201 t-I- Occ 2
‘:'.
Pllan�'Match Approved Land Use:
Rg Site Plan Gi"-Landscape Plan
❑ Urban Forestry Plan C - Elevation Plan t.
[uilding Height: Maximum Height eac-1— Actual Height NJ Or
Conditions Met: ❑ Prior to Permit Submittal ❑ Prior to Permit Issuance
Approved by: tAA (X Date: 4- 30.1 y-
Notes:
6
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved ❑
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Building Permit Submittal r -N p
Original Plan Submittal: Date: 14/4/ By: LJ -,121/7 O
Site Plans: # ---- Q
Building Plans: # 3
Create Case Record#: Enter case#above for Building Permit Number.
Workflow Routing: [Planning Ele-tngineering EPermit Coordinator O'Building
Workflow Sign-off: ri2"--Sign-off for Planning staff,including notes from planning review(page 1)
Route Application Documents: f2Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
'wilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Reviewed By: 6.1_---\___) ( Date: 4/6{
Notcs:
1:\Building\Forms\BIdgPermitRvw_COM_W ithLandUse_123013.docx
Engineering Review— reviewed by: 7__ ire,J
❑ Actual Slope:
❑ PFI Permit#
❑ Conditions Met
Notes: N !s &N co t/.1 Se(..-=' [•■1 C, U s �S ,
Approved by: _` Date: ,,s', ig
Revisions (after Building Submittal only) Reviewer Date
Revision 1 Approved ❑ Not Approved El
Revision 2 Approved ❑ Not Approved ❑
Revision 3 Approved ❑ Not Approved ❑
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
Notes:
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant
Revision Notice 3: Date Sent to Appli / t i
Okay to Issue Permit- ` �Li Date: l /
I:\Building\Forms\BldgPermitRvw COM_WithLandUse_123013.docx