Permit U CITY OF TIGARD t SITE WORK PERMIT
3 COMMUNITY DEVELOPMENT erAleal Permit#: SIT2014-00015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2014
Parcel: 2S109ACO2100
Jurisdiction: Tigard
Site address: 14850 SW 132ND TER
Project: Alberta Rider Subdivision: WOODSIDE Lot: PTS 8-9
Project Description: Construction of 143'of ADA sidewalk for future use. New gate installed to access sidewalk.3/31/15,REPRINTED
to change contractor
Contractor: CONCRETE CONSTRUCTION CO INC Owner: TIGARD-TUALATIN SCHOOL DIST 23J
18205 S GRASLE RD ATTN: BUSINESS MANAGER
OREGON CITY, OR 97045 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-631-4482 PHONE: 503-431-4017
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 09/29/2014 $123.72
Plan Review 09/29/2014 $80.42
Type of Use: COM 12%State Surcharge-Building 09/29/2014 $14.85
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 09/29/2014 $4.00
11x17)
Project Valuation: $5,000.00 Erosion Control w/Permit-Eng 09/29/2014 $75.00
Misc Administration Fee 03/03/2015 $45.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
I Total $342.99
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 dir uestio OUNC b calli 503.232.1987 or 1.800.332.2344.
Iss ed By: K (�/�� j� ��,_ /� j 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 AoplicatifCEJVED
Site Work , I ,,,,(.11I( I. I .L(►.11
IIICity of Tigard AO 4 2014 Q� Pte'"o . /7020/ �d/5
13125 SW Bail Blvd. r,gard,OR 972 3 p�Rn
0 Pltor,r 503 718.2439 Fax. 50 OaaeB - • ���`.other �
, ,, ,.,, Inspection Ltne. 503.639.4175 Ll 1' �+TIGARD �Ready/By % ,"" E See Pate 2 for
Internet www ngard-nr gorBU1LD/NC DI1'ISIQN , ��/y .!%�' Supple...mug t.Eara•atiaa
a)/Axe -N ti ' '
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING -
❑New construction ❑Demolition Permit fees'are based on the value of the work performed 'V
Indicate the value(rounded to the nearest dollar)of all
el Addition/alteration/replacement ❑Other: t 1( equipment.materials.labor.overhead,and the profit for the
CATEGORY OF CONSTRUCTION ' 1 .i1i/I work indicated on this application _- --
❑ I-and 2-family dwelling ®Commercial/industrial k,�1'� Valuation. S
❑Accessory building ❑Multi-family V;t — Number of bedrooms. n
❑Master builder ❑Oilier 'I�}‘� Number of bathrooms �J
JOB 5a7'E INFORMATION AND LOCATI o N Total number of floors
Job site address: 14550 SW 13Ya Ter `' New dwelling area square ten
tv
City/State/ZIP:Tigard.Oregon 97224 Gatage/carpon area square feet
Suite/bldg./apt no.: I Project name:Alberta Rider ADA Path Covered porch area square tees
)$.....
Cross street/directions to job site SW Bull Mountain Rd Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l Lot no 2100 Permit fees'are based on the value of the work performed
Tax map/parcel ra.:02501 N'09AC 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
Constructing approximately 1431.E of 411 wide ADA sidewalk for future use.New Valuation $55,000.00
gate will also be installed to access sidewalk. Existing building area square feel
New building area. square feet
0 PROPERTY OWNER ' ❑ TENANT Number of storks.
Name Tigard Tualatin School District Type of construction:
Address 6960 SW Sandburg St Occupancy groups.
City/State/ZIP:Tigard.Oregon 97223 — �� Existing. V --�— -- •
{. 3N Fax ) — — --
New:
® CONTACT PERKIN NOTICE
Business name Cardno All contractors and subcontractors are required to be
Contact name.Jake Wiser licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to he licensed in the
Address 5415 SW Westgate Dr.Suite 100 jurisdiction in which work is being performed.if the
City/Stater/.IP. Portland.Oregon 97221 applicant is exempt from licensing.the following rearm,
apply
Phone (503)419-2500 [ Fax (503)419-2600
E-mail:jake.wiser @cardno.com -- 6.7 r 3/Og 7A3//r
CONTRACTOR
Business name.TBD 0 N Rv," / /LQ/N� - BUILDING PERMIT FEES*
Amy �2ZZ 0 • - G. Maas veer IsRwtdr ii
Nump—op- Structural plat review lit(or deposit)
City/State/ZIP (D/9/L.6$ ` 9222
Phone ( . i �/ 1^r1 8, FLS plan review fee(if apphtxbk)
CM he. �,j�/,, Total fees due upon application
Authorized signature: y Amount received
✓ This permit application expires if a permit is not obtaiaed
* I J • within 1110 days after it has been accepted as complete.
Print name: P t tip (Ale eN Z 1 Date. Mt 1 •i j • Fee methodology set by Tri.Counts Building Industry'
Service Board
I1 Budd ingVkmits>SII-PermitAppdoe 10/01/09 440-46131111/02C)MWFBI C6M14T2,ernoti) &,"o4 r€ de /A)c
ea,6: (07 3 cif 7(3//S /V.2-v6- 3 612-dKzt: kb
6C,;-6o3i- 44 g;4- CZ*de.: '',Ty eZ 9704/5'
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III ■ Request for Permit Action
T G A It , 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov
FROM: ❑ Owner K Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: � 1
INVOICE TO: (Business or Individual) / /T 1
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: -/-r",,)0/1/-- OoO t c
Site Address or Parcel#: /Y 4 SD W /301/ 7I2
Project Name: AL/✓r/7 , £i f2 A.b&A:A t_/l, PA-TH-
Subdivision Name: /f Lot#: /✓/jq
EXPLANATION: 0...`1an Ad, 00 A -'7 fL Pia w► gu 13 P,✓cZ 4u1z-a,,id-
-o C'o,J Gl er Ts 601.) T.6(c7-/o,J /.0C'_. , ee6 ii& (7398,
6,0 2trE do,15feue at) Ca /47 /twos"6 Q ea tai ot.o.,0,..3 G ,0X 976)(4--
Signature: Date: ,,11/5//S
Print Name: P1 Li/3 lu',t.T.`,
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
•
Route to Sys Admin: Date /S Route to Records: Date -By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPennitAction_092314.doc
CITY OF TIGARD SITE WORK PERMIT
t COMMUNITY DEVELOPMENT Permit#: SIT2014-00015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2014
Parcel: 2S 109ACO2100
Jurisdiction: Tigard
Site address: 14850 SW 132ND TER
Project: Alberta Rider Subdivision: WOODSIDE Lot: PTS 8-9
Project Description: Construction of 143'of ADA sidewalk for future use. New gate installed to access sidewalk.
Contractor: SUN RIVER BUILDINGS Owner: TIGARD-TUALATIN SCHOOL DIST 23J
12220 SW JAMES ST ATTN: BUSINESS MANAGER
TIGARD,OR 97223 6960 SW SANDBURG ST
TIGARD,OR 97223
PHONE: 503-608-2739 PHONE: 503-431-4017
FAX: 503-213-6538
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 09/29/2014 $123.72
Plan Review 09/29/2014 $80.42
Type of Use: COM 12%State Surcharge-Building 09/29/2014 $14.85
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 09/29/2014 $4.00
11x17)
Project Valuation: $5,000.00 Erosion Control w/Permit-Eng 09/29/2014 $75.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $297.99
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, - . e of : Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit w expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law req res you to follow he rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA- 952-001-0090. Y. may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3
Issued By: ••rmittee Signatur:•
I�1
Call 50 .•3•.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1.76, 4.•
Building Permit Anplicati i CEIVED
Site V '/ 1 R OFFICE I'SE ONLY
City of Tigard Q A 2014�� to t3 y /V- w -�LJ PMmt Nu j!! 0/ �o/5'`
13125 SW Hatt Blvd„Tigard,OR 97223 `t ,,,ReY1 r• A.�-+
' ' I Phone: 503.718.2439 Fax. 50 . p•tc,-gy 1� Other Permit.
1 i i Inspection Line: 503.639.4175 l,i j V)FTIGARD Date Ready/By. hen i?i See Page 2 for
Internet: www.tigard-ar.govBii1LT Notified/Method di/al/7 1. Supplemental Information
l/1 WM!. nfIr rO0 ' k� .—ivy earrAdir- 74
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING �c
❑New construction ❑Demolition Permit fees"are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the .,
CATEGORY OP CON$rRUCTION -work indicated on this application.
❑ I-and 2-family dwelling 0 Commercialiindustrial
Valuation: S
❑Accessory building ❑Multi-family
' Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms.
JOB SITE INFORMATION AND LOCATION Total number of floors: p
Job site address: 14850 SW 132id Ter New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97224 Garage/carport area square feet
Suite/bldg./apt:no.: I Project name:Alberta Rider ADA Path Covered porch area: square feet fl
Cross street/directions to job site:SW Bull Mountain Rd Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.:2100 Permit fees''are based on the value of the work performed
Tax map/parcel no.:02S01W09AC
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.
Constructing approximately 1431.1;of Jft wide ADA sidewalk for future use.New Valuation. $55,000.00
gate will also be installed to access sidewalk. Fs'sting building area square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name Tigard Tualatin School District Type of construction: �Z
Address:6960 SW Sandburg St Occupancy groups:
City/State/ZIP:Tigard,Oregon 97223 Existing. - —
Phone (503)431-4017 his t 1 New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name:Cardno -- All contractors and subcontractors are required to be
Contact name:Jake Wiser licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5415 SW Westgate Dr.Suite 100 jurisdiction in which work is being pm formed.1f the
City/State/ZIP Portland,Oregon 97221 — applicant is exempt from licensing.the following reasons
_amply:
Phone:(503)419-2500 I Fax (503)419-2600 — ---- ---------
E-mail:jake.wisercardno.com
CONTRACTOR
Business name:TBD p ,/,/
-!.51.�N /5/!/�l2 .d.L�/LO�N� BUILDING PERMIT FEES*
Address: /22Z 0 .</0 (Mosenlarin fat:seie hdr)
- — Structural plan review fee(or deposit):
City/State/ZIP: LOle 9122.g p
Phone ($ 7 �,- 2 9 tax:(�63) 2'/— (�38' }'l.s plan review fee(ifapplicable):
-
C CI3 lie. /o1P fat Total fees due upon application: -
Llyi Amount received:Authorised signature: This permit application expires if permit is not obtained
within 180 days atter it has been accepted as complete.
Print name: soh t L t P toe rit 7 Date: 7/..3/1 1 y I • Fee methodology set by In-County Building Irufusuy
Service Board
1\BuildingWennitstSIT-PermitApp.doc 10/01/09 440-4613'1(11/02/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
till 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: 11 cu.yds.
Grading Volume:
(Soils report required for>5.000 cu.yds.) 22 cu.yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) 11 cu.yds.
Retaining structure? (Check one) Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 572 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
)l Gradin_ 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 5(X)to$5(X)(x)� $51.09 minimum permit fee
Alterations) Submittal $500 01 to$1000 00 $51.09 for the Oral$500 00 and
$2-69 for each additional$100 or fraction
Commercial 3 _ thereof,to and mcludmg$2,(xx)(x)
$2,0}0 01 to$25,000 00 $91 44 for the first$2,000 00 and
Multi-Family R-I Occupancy 3 510 76 for each additional$19(x)or
fraction thereof,to and including
$25,00)(x)
One-&Two-Family Dwelling 2 $25,000 01 to$50.000 00 $338 92 for the first$25,000.00 and
$806 for each additional$1,000(xl or
• fraction thereof,to and including
$50,(XHl.00
$50.001.00 to$100,000 00 $540 42 for the first$50,000 00 and
$5 38 tot 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
t AualdmglPermiu 55rf-PermitApp.doe 05!2512012 2
RECEIVED
AUG 4 2014
CITY OF TIGA `I" Cardno
TRANSMITTAL BUILDING DIVISION WRG
Shaping the Future
To: Building Division Date: 07/31/2014
Alberta Rider ADA
City of Tigard Project: Sidewalk 5415 SW Westgate Drive
Suite 100
13125 SW Hall Blvd. Project#: 21407620 Portland,Oregon 97221
USA
Tigard, OR 97223 Case/File#:
Phone (503)419.2500
Fax#: Total Pages: Fax (503)419-2600
From: Jake Wiser
www.cardnowrg.com
Transmitting Via: Purpose:
❑ <Select> ® As Requested
Other: Delivery ❑ Other:
Quantity Description
2 Full Size Site Work Plan Set(2 Sheets)
1 Site Work Application
Comments:
Please see completed Site Work Application with attachments.
Thanks
Jake Wiser
Signature:
C:
Australia • Belgium • Indonesia • Kenya • New Zealand • Papua New Guinea
United Arab Emirates • United Kingdom • United States • Operations in 60 Countries
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A K D Building Permit Review — Commercial - No Land Use
Building Permit #: 1 -0 00/6-----
Site Address: 1,41350 s w 13a nd "(e.-r . Suite/Bldg#:
Project Name: 00 I
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: -'n S4-s.11 a-vx A-DA S,(4c 41c rt ui f_ _ pf
cuk_ W -1-11 6tcr-eas s, e w c .
Existing Business Activity: ,h u
Proposed Business Activity: SGr, vv
❑ Verify site address/suite #exists and active in permit system.
0 Zoning: R- 7
0 Permitted Use: y Yes ❑ No ❑ Spec Space
Confirm no land use required.
Notes:
Approved by Planning: CikwC a - Date: a-4-14
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
Original Submittal Date: g/q//1
Site Plans: # i71-
Building Plans: # .?`
Building Permit#: Im" 1~:nter building permit#above.
Workflow Routing. planning EPP—e mit Coordinator -R Wuilding
Workflow Sign-off: g'Sign-off for Planning(include notes from planning review)
Route Application Documents: .Building. original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Techni ian: t\ { Date: 0/
I:\Building\Fonns\BldgPermitRvw_COM NoLandUse 071514.docx
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
17'•K to Issue Permit
Approved by Permit Coordinator: • Date: X/11j'/
1:\Bu ilding Worms\B IdgPerm itRvw_COM_NoLandUse_07 1 5 14.docx