Permit CITY OF TIGARD SITE WORK PERMIT
• COMMUNITY DEVELOPMENT Permit#: SIT2015-00009
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2015
Parcel: 25102AB04500
Jurisdiction: Tigard
Site address: 12430 SW MAIN ST
Project: Tigard Strolling Street Project Subdivision: KINGSTON Lot: 2
Project Description: Remove and replace hardscape in front of(3)properties,on private property.
Contractor: ANNECO LLC Owner: CAPISTRANO, NICOLAS N REV LIV TR
PO BOX 812 CACH, CHRISTOPHER J
NORTH PLAINS, OR 97133 6003 4TH AVE NE
SEATTLE,WA 98115
PHONE: 503-807-6940 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/24/2015 $532.36
Plan Review 08/24/2015 $346.03
Type of Use: COM 12%State Surcharge-Building 08/24/2015 $63.88
Class of Work: ALT Erosion Control w/Development 08/24/2015 $107.60
Info Process/Archiving-Lg$2.00(over 08/24/2015 $14.00
Project Valuation: $48,500.00 11x17)
Site Specifics:
Excavation Volume: 20 cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 983 sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: No
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: No
Fence: No
Total $1,063.87
• 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, o ' • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Ce•ter. 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= t questions to 0 N = calling 503.232.1987 or 1.800.332.2344.
Iss ed By: AI/ 4 / Signature: /\ ,/�`1`� •
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.
c Iuilding Permit Application
Site Work (`� (�T tOIt (HI I( I 1 ,t ()NI l
IIII City of Tigard REC23 EI i'EP Received ' �i�� Permit No.• '• _��,s
• DateB : ��)I
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi
:e �'
Phone: 503.718.2439 Fax: 503.598.19 Other Permit:
' I I It I Inspection 503.639.4175 AUG 3 2015 Date Ready/ . , furls. la See Page 2 for
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Internet: Line:www.tigardor.gov ' [ �Q -Notifiied/MMethod: , �• / Supplemental Information
N1SION REQUI' ' 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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I.and 2-family dwelling Valuation: $
❑Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
41116J Master builder ❑Other: Number of bathrooms:
r
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1)_'(1,0 i 1 2.-NA 3 / 0,4 4 L S w t'Ak.•+ t'. New dwelling area: square feet
-'(j City/State/ZIP: Ti&A-A-0 / a{{„ Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: -n&11440 S j A95(.f i i✓C ir,2_e r Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
At bdivision: I 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
equipment,materials,labor,overhead,and the profit for the
el DESCRIPTION OF WORK work indicated on this application.
a.: N es
Valuation: $ Y a 6-Dr)
_ REtii0v£ A-ND REeLi- /rit 5CAPe p.d 1
Fay T of (3) PIto P 1cR ri l;S / ON Pk I 1!/t7‘ Existing building area square feet
• L40 . New building area: square feet
•11 ❑ PROPERTY OWNER ❑ TENANT B iv t,/j Z' Number of stories:
J Name: l'.HRt S Chs(^I Vu t Le La D a 12/tM Ittea Type of construction:
Address: 1 zy 30 l 11.41 lc. S v, re.)IT 11.it 4 L S va MA-1" VrRGT Occupancy groups:
City/State/ZIP: '(j C*sD r 0 I< 91113 Ti Gloto t c 2 `1'1 2.1-S Existing:
• Phone:(503) Q t[3"' OO4 9 1 4tteL(323) S(.ti - 4561) New:
_ ❑ APPLICANT ❑ CONTACT PERSON
/� NOTICE
c.� Business name: kNNEC 0 G?NS'T'A-btc,T1 CN I,I.0. All contractors and subcontractors are required to be
Contact name: 0 U b�12-Gale licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be Ii ensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
3 Phone:(s03) Ur,- (0 9 4 U Fax: :( )
E-mail: aOUy . befit{ € Ccv ce.S} ."e-1 L
CONTRACTOR
...i. . Business name: IT„ N oG0 Co,ST aAA.cpt 0 1 L.,C, BUILDING PERMIT FEES*
P O Qi0 (Please refer to fee schedule)
Address: X 5(IL
Structural plan review fee(or deposit):
City/State/ZIP: N o(LTK PLM 1J S 1 o L 91 133
FLS plan review fee(if applicable):
a Phone:(503) bit S _ (o S'LS
CCB lic.: 1 5 Fax:( )
Q , c 9 t /�_a(14, Total fees due upon application:
t (
A pk n Amount received: ''..e---”
Authorized signature: [yam Or,i This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Dm G ( "ie- Date: g-I3 x-2015 * Fee methodology set by Tri-County Building Urdu
Service Board CL.lt1Zt/
I:\B dding\Permits\SlT-PermitApp.doc 10/01/09 /40 440-4613T(IL/02/COM/WEB / ��„�V
6--e--k: et /3-1 4--vt-I. /.4t_a ttolt, 4441110 40.4-11-4.1,
•
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 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 $.0o 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.
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11111 ■
Site Work Permit Application
Plan Submittal Requirements
r 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 labeled with:
A. ❑ map & tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
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:
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.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
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-PermitApp.doc 05/25/2012 3
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3) illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to 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.
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