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Permit IWASOI 11 CITY OF TIGARD SITE WORK PERMIT 111 = COMMUNITY DEVELOPMENT Permit#: SIT2014-00019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/30/2014 Parcel: 1S 135BD00200 Jurisdiction: Tigard Site address: 9785 SW SHADY LN Project: Shady Lane Drive-through Subdivision: ASHBROOK FARM Lot: PTS 5& Project Description: Site work for shell remodel of a former gas station building. 12/30/2014: REPRINTED to add erosion control inspection requirement. Contractor: TEAM CONSTRUCTION GROUP INC Owner: NORED, STANLEY D&AUDENE C 4201 NE 66TH AVE SUITE 105 511 NE 21ST PL VANCOUVER, WA 98661-3078 CANBY, OR 97013 PHONE: 360-699-1477 PHONE: FAX: 360-699-1454 FEES Description Date Amount Specifics: Permit Fee-Site Work 12/30/2014 $1,258.42 Plan Review 10/30/2014 $817.97 Type of Use: COM 12%State Surcharge-Building 12/30/2014 $151.01 Class of Work: ALT Erosion Control w/Development-Eng 12/30/2014 $236.40 Project Valuation: $200,000.00 Site Specifics: Excavation Volume: 74 cu.yd. Fill Volume: 74 cu.yd. Impervious Surface: 13072 sq.ft. Engineered Fill: No Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Store Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: Yes Total $2,463.80 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 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 OW bycalling 503.232.1987 or 1.800.332.2344. Issued By: re6. 'A, 9�j- 7 Permittee Signature: (../i/ nL/Crg_70 / ,_ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. / v 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. CITY OF TIGARD SITE WORK PERMIT 3 COMMUNITY DEVELOPMENT Permit#: SIT2014-00019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/30/2014 Parcel: 15135B000200 Jurisdiction: Tigard Site address: 9785 SW SHADY LN Project: Shady Lane Drive-through Subdivision: ASHBROOK FARM Lot: PTS 5& Project Description: Site work for shell remodel of a former gas station building. Contractor: TEAM CONSTRUCTION GROUP INC Owner: NORED, STANLEY D&AUDENE C 4201 NE 66TH AVE SUITE 105 511 NE 21ST PL VANCOUVER,WA 98661-3078 CANBY, OR 97013 PHONE: 360-699-1477 PHONE: FAX: 360-699-1454 FEES Description Date Amount Specifics: Permit Fee-Site Work 12/30/2014 $1,258.42 Plan Review 10/30/2014 $817.97 Type of Use: COM 12%State Surcharge-Building 12/30/2014 $151.01 Class of Work: ALT Erosion Control w/Development-Eng 12/30/2014 $236.40 Project Valuation: $200,000.00 Site Specifics: Excavation Volume: 74 cu.yd. Fill Volume: 74 cu.yd. Impervious Surface: 13072 sq.ft. Engineered Fill: No Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Stom Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: Yes Total $2,463.80 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 Q JNC by calling 503.232.1987 or 1.800.332.2344. Issued By: d,...> y� ��' 7„._ Permittee Signature: 401,V/. °��l i'�7� 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. Bo/Mink Permit Application Site Vork FOR OFFICE USE ONLY Received City of Tigard Date/B : „ Permit No. r r 01111 il 13125 SW Hall Blvd.,Tigard,OR 97223 I. (`1 �� Other Permit: Phone: 503.718.2439 Fax: 503.598.1 \ �� Da e Bee t���'/.� % ,S 7 TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris 7A See Page 2 for Internet: www.tigard-or.gov 7S Notified/Method: �� Supplemental Information °87`WORK 7,' `GO REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ` C 0.} Permit fees* are based on the value of the work performed. ❑ D } Nr~ ��1510� Indicate the value(rounded to the nearest dollar)p f all ®Addition/alteration/replacement ❑Q 1,1d r. R equipment,materials,labor,overhead.and the profit for the v� work indicated on this application. CATEGORY OF CONSTRUCTION ❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑ Master builder ❑Other: Number of bathrooms: N JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:9785 SW Shady Lane New dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:Retail @ Shady Lane Covered porch area square feet Cross street/directions to job site:SW Greenburg Road&SW Shady Lane Deck area: square feet Other structure area: square feet PA ttfill REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: �/�� of no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.:1S 1-35BD 00200 Imo" Indicate the value(rounded to the nearest dollar)of all P equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF 'ORK work indicated on this application. Site permit for shell remodel of former gas station building Valuation: $$200,000.00 Existing building area n/a square feet New building area: n/a square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: n/a Name:Mike Jenkins Type of construction: n/a Address:300 West 15t°Street,Suite 200 Occupancy groups: City/State/ZIP:Vancouver,WA 98660 Existing: n/a Phone:(306)823-5102 Fax:(360)823-1102 New: n/a 4, 0.,APPLICANT 1 ® CONTACT PERSON NOTICE Business name:Mackenzie fi �/ SL�trytt Tf r (�� All contractors and subcontractors are required to be Contact name:Suzannah Stanley i ��,ak. 1 licensed with the Oregon Construction Contractors Board t!� under ORS 701 and may be required to be licensed in the Address:1515 SE Water Avenue,Suite 100 jurisdiction in which work is being performed. I f the City/State/ZIP:Portland,OR 97214 applicant is exempt from licensing,the following reasons 3 �ew apply" Phone:(503)224-9560 '(g* ) l5 �51 A _ E-mail:sstanley @mcknze.com I rcexrA-1'10141-e-1-1.1a4schutt tsc "co,,, CONTRACTOR —__1 Business name:Team Construction (,G,,p I t'- _ BUILDING PERMIT FEES* Address:4201 NE 60 Avenue,Suite 105 (Please refer to fee schedule) Structural plan review lee(or deposit): City/State/ZIP:Vancouver,WA 98661 97% 7 Phone:(360)699-1477 / Fax:(360)699-1454 FLS plan review tee(if applicable): - CCB lic.:73179 1 car Total fees due upon application: ! Amount received: —1 -Authori .tg This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. Print name:Paul Hodge Date:10/29/14 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\SIT-PermitApp.doc 10/01/09 440-4613T(1l/02/COM/WEB) J 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: 74 cu.yds. Grading Volume: (Soils report required for>5,000 cu.yds.) 148 cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90%of maximum density) 74 cu.yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 13,072 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: TYPE OF SUBMITTAL #of Plans Permit Fee: (New,Additions or Required at Valuation: Permit Fee: Alterations) Submittal $.00 to$500.00 $51.09 minimum permit fee Commercial ; $500.01 to$2,000.00 $51.09 for the first$500.00 and $2.69 for each additional$100 or fraction thereof,to and including$2,000.00. Multi-Family R-1 Occupancy 3 $2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and $10.76 for each additional$1,000 or fraction thereof;to and including One-&Two-Family Dwelling 2 _ $25,000.00. $25,000.01 to$50,000.00 $338.92 for the first$25.000.00 and $8.06 for each additional$1.000 OO 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.doe 12/30/05 440.46131(11/02/COM/WEB) City of Tigard COPY v COMMUNITY DEVELOPMENT DEPARTMENT I TIGARD Building Permit Review — Commercial - With Land Use Building Permit #: 3 .7;20t'i- 0i'/ Site Address: cYlattt ter, Suite/Bldg#: Project Name: (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: .t►: A' A'. ._ c L �� .' a . ■ a .m — / ,1 a v' L O F, - c\at;p c�sC �: k um prn•�-r41 . L� Verify site address/suite #exists and active in permit system. LJ Land Use Case #: SD2 W 4- -000c 3 ❑ Plans Match Match Approved Land Use:�/ L� to Plan LJ Landscape Plan ❑ Other: [? Urban Forestry Plan ❑ Elevation Plan Building Height: Maximum Height Actual Height 10 ❑ Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance Notes: �t - `;i k 9Ir ' �� ■ (-:.hd 4- t)G Q IU.X1S V p+d:1-d-1 (!,^_r&> r (.2 Approved by Planning: 1 JU(L I SSa G,ras s Date: 0 1 ?)D 1 1.4 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved . ;r.'�t r.r - .71 W , rss.uir a cTSCSa' e!31r .ai•- 0-:d it-I, 'c.:+_s Building Permit Submittal Original Submittal Date: 40/34h 7 Site Plans: # 3 Building Plans: # Building Permit#: nter ding permit#above. Workflow Routing: la geering LJ 'ernut Coordinator Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: ding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Date: /Vje/Ay [:\Buiiding\FormskBldgPermitRvw_COM_WithLandUse 042914.docx Engineering Review Actual Si • ❑ PFI Permit#: RE6. v; .,e,..P ❑ Conditions Met Notes: • Q ,4 v i S e -To co W/L sdn Os b. R f u8 wei T. • L) a Y prPpla.04(,H 4 DA Go.../Ow Let j fie ff • A D A Riwtp AT Gog,eRz of l,rTg4 SGc,Q"/oAl • S rd O�.J . C W a's P 9AMJ• To Al h, . , Approved by Engineering: / Date: I (1 • 30 •/�j/ Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 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: 71/OK to Issue Permit Approved by Permit Coordinator: / Date: fiN 1:\Building\Forms\BldgPermitRvw COM_WithLandUse_042914.docx MACKENZIE 1515 SE Water Ave.Suite 100•Portland OR 97214 PO Box 14310•Portland OR 97293 TEL:503.224.9560•NET:MCKNZE.COM•FAX:503.228.1285 Letter of Transmittal 54682-1 Date: October 30, 2014 Project Number: 2130043.16 To: City of Tigard 13125 SW Hall Blvd Tigard, OR 97223-8199 Attention: Project Name: Shady Lane - Land Use and Permitting Assistance Enclosed: Quantity Medium Description Comment 1 Original Building permit application form For your use 1 Original Site permit application form For your use 1 Original Building and site permit check For your use 1 Bond Full Permit plans-original stamped For your use 3 Bond Full Permit plans-copies For your use 2 Original Calcs For your use Remarks: Signed: Suzannah Stanley Transmitted Employee Delivery (shs) Via: If enclosures are not as noted, kindly notify us at once. .+/✓ . CityofTigard ORIGINAL COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Commercial - With Land Use Building Permit #: ,S t Tz2 A- coot'/ Site Address: Ct1R5 clA; Snc j i Suite/Bldg#: Project Name: (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: 2 1'Y\C(12i fl .04."W �)�l�lncl t.UI Gi Smaii) (t c .4 ht� c- d-1 — EA/Verify k- Hui�I'� �0 c1�1cp 4. r1 ScCrldd�rl ��_1-r �,�Yt pm.V-111112.4/07C site address/suite #exists and active in permit system. 12 Land Use Case #: S�Q.'Lot - -0000 3 ❑ Plans Match Approved Land Use:�/ to Plan LyJ Landscape Plan ❑ Other: Urban Forestry Plan ❑ Elevation Plan Building Height: Maximum Height Actual Height hi ❑ Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance Notes: ; c•IU.r1S L, acute -t--t re t✓ld�,f d ife[,F'IG7 ca CI0 n (per (=Chrr11-1c S� L dSa - 4- J G Ouxu U p�+cti-c-1 c�c CLYAt V Approved by Planning: ik(>y SStt GroS S Date: a?)0/ I4 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 3 -1.1, ="" F. ;�,a U. ., . ..__. Building Permit Submittal Original Submittal Date: /0/31/ Site Plans: # Building Plans: # 3 Building Permit#: r ding permit#above. Workflow Routing: —Fla ering l '15—e�i t Coordinator a--tr-----nlding Workflow Sign off: Sign-off for Planning(include notes from planning review) Route Application Documents: ding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: C_ By Permit Technician: Date: /eY Ai I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 042914.docx Engineering Review • Actual Sl ❑ PFI Permit#: REE5LV j ie,.E P ❑ Conditions Met Notes: • R * v Is -ro CdO wt fie_y W/L 4 n U.c e �1i Rif s uB aet T. • 1,44Y A.Pr. .o4C,M 4 DA ay.,,pw A.ai ,)a( 14 D A R>i,wtf AT GoRNe,e os /�Tg4.50c.O'/vAl �Y • y octOto.l I e I dot: Go.vN. iv I11,wAI A Approved by Engineering: �� Date: I • 30 -/y Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved 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: XOK to Issue Permit hApproved by Permit Coordinator: / Date: /317,141 I:\Building\Forms\BldgPermitRvw COM_WithLandUse 0429I4.docx Building Permit Application r .. Site Work FOR OFFICE USE ONLY City of Tigard Received g �� tt a %1 Permit No.: , Q " 13125 SW Hall Blvd.,Tigard,OR 97223 {r�, Plan Revie • Phone: 503.718.2439 Fax: 503.598.19g� DateiB Other Permir TIGARD Inspection Line: 503.639.4175 DateReady/By: Juris El See Page 2for Internet: www.tigard-or.gov 7-‘/�A Notified/Method: 7-x„.6 Supplemental Information fi R TYPE OF WORK C 11 REQUIRED DATA:1-AND 2-FAMILY DWELLING CC roc Nita ❑New construction ❑Det' Di n�t �(�N Permit fees* are based on the value of the work performed. �S v Indicate the value rounded to the nearest dollar)of all ®Addition/alteration/replacement ❑Q11[j' 11�1G equipment,materials,labor.overhead.and the profit for the DD��'"'` CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I-and 2-family dwelling Valuation: S y g ®Commercial/indust ❑Accessory building ❑Multi-family p Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:9785 SW Shady Lane Ness dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square tel --H Suite/bldg./apt.no.: Project name:Retail @ Shady Lane Covered porch area: square feet Cross street/directions to job site:SW Greenburg Road&SW Shady Lane Deck area: square feet 1 Other structure area: square feet lfil4 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: of no.: Permit fees* are based on the value of the work perlbrmed. Tax map/parcel no.: 15-1-35BD 00200 � Ind icate the value(rouided to the nearest dollar)of all equipment,materials,labor.overhead.and the profit for the DESCRIPTION OF RK work indicated on this application. Site permit for shell remodel of former gas station building Valuation: SS200,000.00 Existing building area n/a square feet New building area: n/a square feet ® PROPERTY OWNER ❑ TENANT Number of stories: n/a Name:Mike Jenkins Type of construction: n/a Address:300 West 15th Street,Suite 200 Occupancy groups: City/State/ZIP:Vancouver,WA 98660 Existing: n/a i Phone:(306)823-5102 Fax:(360)823-1102 New: n/a ® APPLICANT , j ® CONTACT PERSON NOTICE Business name:Mackenzie T�w�! �(.Mtt41t (�.�'" All contractors and subcontractors are required to be Contact name:Suzannah Stanley ��� 1;10,..0.4. licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address:1515 SE Water Avenue,Suite 100 jurisdiction in which work is being performed I f the City/State/ZIP:Portland,OR 97214 applicant is exempt from licensing.the following reasons apply: Phone:(503)224-9560 i`(`)5 ) 2:10-i5 E-mail:sstanley @mcknze.com a —'-i l r�cx- v144 lam-G�;lar�s(r�t�rttel�No" ) CONTRACTOR Business name:Team Construction BUILDING PERMIT FEES* Address:4201 NE 66th Avenue,Suite 105 (Please refer to fee schedule) Structural plan review fee(or deposit): City/State/ZIP:Vancouver,WA 98661 Phone:(360)699-1477 ,) FLS FLS plan review lee(if applicable): CCB tic.:73179 Total tees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name:Paul Hodge Date: 10/29/14 * Fee methodology set by Tri-County Building Industry Service Board. I:1Building\Permits\SIT-PermitApp.doc 10/01/09 440-4613T(1l/02/COM/WEB)