Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
March 4, 2011 z 7
WH Pacific, Inc.
Attn: Brady Berry
9755 SW Barnes Rd., Ste. 300
Portland, OR 97225
Re: Permit No.: SIT2009-00021
Submittal Date: 12/24/2009
Project Name: Dave & Busters
Site Address: 10125 SW Washington Square Rd.
Dear Applicant:
This letter is to notify you that your permit application referenced above has expired in
accordance with the administration chapter of the Oregon Specialty Codes. Applications
are valid for a maximum of 180 days from the submittal date. The City of Tigard has not
received a written request for extension therefore it is expired by limitation.
In order to reactivate this permit, a new application, building plans, if applicable, and
permit fees are required to be resubmitted and a new permit number will be assigned.
If you have any questions, please contact the Building Division at 503.718.2439.
Sincerely,
City of Tigard
Building Division
cc: Property File
•
Ltr-Sub-Exp.docx 02/01/201I
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard-or.gov • TTY Relay: 503.684.2772
6125 et.w42 .19,-cos&-
• , ��ding Permit Application
Site Work EXPIRED 3A, FOR OFFICE USE ONLY
N Received Q y 1 /a
City of Tigard D Date/By: r/ 6 I Permit No.:/ r,„109- w
^
I - - 13125 SW Hall Blvd.,Tigard,OR 97223�(ECF I Plan Review
Phone: 503.639.4171 Fax: 503.598.19 ��l 1. Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 ,loon Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard-or.gov DEC 9 Notified/Method: Supplemental Information
TYPE OF WORC ITY C't- f i(i APO
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
ddition/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 mmercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
111 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /0 bg S St;0 41.9 �dicn/J r -u�et--- go New dwelling area: square feet
City/State/ZIP: 77614.a0 to Garage/carport area: square feet
i Suite/bldg./apt.no.: Project name: awe)..646- ) Rip DEV, Covered porch area: square feet
Cross street/directions to job site: /, 11ST.l,NF�4i Jzu p�A,) i Deck area: square feet
S� ��+2CLr1vaU�G- p. Other structure area: square feet
I REQUIRED DATA:COMMERCIAL-USE CHECKLIST
h_
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
/ 5 S!�/��i'cc)/C� equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4-i (,/77L i 77/3 A-n•0 P/4't. r/�/G. Valuation: $ I,/(IQ
�yCC�tti7 anin/ 1 O
\C\ Existing building area: square feet
�� New building area: square feet
111/PROPERTY PROPERTY OWNER ,� El TENANT Number of stories:
Name: /1✓f4CY:Z./CH I F/Lapt►2rtf .s4C-trnG1/T — ,CA&It( Type of construction:
Address: #7c/ Gt,I/L 5 i e- i /vD j so 7 7oO Occupancy groups:
City/State/ZIP: .4,,,,7X1 0,, rCAr t!"�9 901/0 / Existing:
Phone:( 2/"1r 3 .// 7 - 7ti35 Fax:(4/y) 3I/7 7:-%.%8 New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Ai//f.4 /f C /�c All contractors and subcontractors are required to be
/
licensed with the Oregon Construction Contractors Board
Contact name:
�lZA
„4y IZI under ORS 701 and may be required to be licensed in the
Address: 97 55- .o-' E.Ail N is gi) ` S �OC) jurisdiction in which work is being performed.If the
!�
_ applicant is exempt from licensing,the following reasons
City/State/ZIP:
R e2r-z. 0 02 gl7775 apply:
Phone:( ) 3 72 J 60 l Fax::(90) S ZCv -d 77 -----7>
E-mail: L / / n
J CONTRACTOR
Business name: / l g(D BUILDING PERMIT FEES*
Address: (Please refer to fee schedule
Structural plan review fee(or deposit):
City/State/ZIP:
Phone:( ) Fax:( ) FLS plan review fee(if applicable):
CCB lic.: Total fees due upon application:
Amount received: / '77g.7
Authorized signature: This permit application expires If a permins not obtained
Print name: G - Date:
` within 180 days after it has been accepted as complete.
!Z 23�dT Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\SIT-PettnitApp. /01/09 44046131(11/02/COM/WEB)
y., 1
4
7
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: 540 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) /,/00 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) /6i/0 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: L f? 73 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 ollowing must accompany this application:
Site Plan with Vicinity Map showing ADA [r *Parking(including ADA)and Lighting
z.compliance Plan
O Grading Plan and details [f *Landscaping Plan
D Erosion Control Plan and details Soils Report(if required)
❑ Retaining Structures
*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 2 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 2 $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 12/27/06 2
II . Site Work Permit Application
Plan Submittal Requirements
T I 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 beled with:
A. a map &tax lot# El/project name E site address [j1uite number
❑ zoning a
D'applicant name pplicant phone number
B. North arrow.
C. Scale (architectural or engineering only)./
D. Street names. cc//
E. Building pads (drawn to scale)with project location.✓
V
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. c/
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. 1/
5) Finish grade elevations along the accessible route. ✓
B. Topographic survey plan showing grade elevations crossing the entire site. i✓
C. Overall grading plan. ✓
D. Utilities plan showing: V
1) Fire hydrant location and pipe size if on private property.f/
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-PennitApp.doc 12/27/06 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection. ✓
4) Any other measure o 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.
I:\Building\Permits\SIT-PermitApp.doc 12/27/06 4