Permit CITY OF TIGARD • SITE WORK PERMIT
g . COMMUNITY DEVELOPMENT / Permit#: SIT2015-00001
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2015
Parcel: 1 S 136C D02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Fuel Facility Subdivision: PALMER ACRES Lot: 3
Project Description: Site work associated with installing of new fueling facility.9/14/15,REPRINTED to add fire line to permit.
Contractor: ROBINSON CONSTRUCTION Owner: COSTCO WHOLESALE CORPORATION
21360 NW AMBERWOOD DR PROPERTY TAX DEPT 111
HILLSBORO, OR 97124-9321 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-645-8531 PHONE: 425-313-8100
FAX: 503-645-5397
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/24/2015 $8,128.12
Plan Review 03/09/2015 $5,283.28
Type of Use: COM 12%State Surcharge-Building 08/24/2015 $975.37
Class of Work: ALT Erosion Control w/Development-Eng 08/24/2015 $1,436.40
Project Valuation: Misc Administration Fee 09/14/2015 $45.00
Project $1,729,681.00
Site Specifics:
Excavation Volume: 2200 cu.yd.
Fill Volume: 0 cu.yd.
Impervious Surface: 45500 sq.ft.
Engineered Fill: No Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: No
Fence: No
Total $15,868.17
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 - cation • er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or di -ct questions to OU by g 03.232.1987 or 1.800.332.2344. �.
Is ued By: U` Permittee Sign.ture:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• 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.
ItCITY OF TIGARD SITE WORK PERMIT
N . COMMUNITY DEVELOPMENT Permit#: SIT2015-00001
TIG.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2015
Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Fuel Facility Subdivision: PALMER ACRES Lot: 3
Project Description: Site work associated with installing of new fueling facility.
Contractor: ROBINSON CONSTRUCTION Owner: COSTCO WHOLESALE CORPORATION
21360 NW AMBERWOOD DR PROPERTY TAX DEPT 111
HILLSBORO, OR 97124-9321 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-645-8531 PHONE: 425-313-8100
FAX: 503-645-5397
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/24/2015 $8.128.12
Plan Review 03/09/2015 $5,283.28
Type of Use: COM 12%State Surcharge-Building 08/24/2015 $975.37
Class of Work: ALT Erosion Control w/Development-Eng 08/24/2015 $1,436.40
Project Valuation: $1,729,681.00
Site Specifics:
Excavation Volume: 2610 cu.yd.
Fill Volume: 2610 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 $15,823.17
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
issue , work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti'y Notification nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-00190 b. Yo y obtain a cop f the rules
or irect questions to OUNC b .fling 503.232.1987 or 1.800.332.2344.
Is ued By: /� /j 1 I 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.
4 Wilding_Permit Application
Site Work RECEIVED lOR OFI•I( E USE ONLY
City of Tigard Received Permit No.: ��
- Date/B : (Ziff/MINIM 5—0
13125 SW Hall Blvd.,Tigard,OR 9722EB 2 3 2015 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : A • `# Other Permit
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: — ]uris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
v
TYPE OF WORK REQUIRED DATA: I-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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: $ 'b
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:7850 SW DARTMOUTH New dwelling area: square feet
;1'
City/State/ZIP:TIGARD OR 97223 Garage/carport area: square feet
n7
Suite/bldg./apt.no.: Project name:COSTCO FUEL FACILITY Covered porch area: square feet
Cross street/directions to job site:PACIFIC HIGHWAY 99 x SW DARTMOUTH ROAD Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed. I
Tax map/parcel no.: 1S136CD02200 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. ( .t4 A DQ'AN)
NEW FUEL FACILITY(18 FUELING POSITIONS)WITH 102'x73'CANOPY Valuation: $$ leocolc_t,7A7J 48!
SITE WORK-CURBS AND PARKING STRIPING Existing building area: square feet
WATER QUALITY IMPROVEMENTS New building area: 3,774 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 1
Name:COSTCO WHOLESALE Type of construction: IIB
Address:999 LAKE DR Occupancy groups:
City/State/ZIP:ISSAQUAH WA 98027 Existing: M
Phone:(425)313.8100 Fax:( ) New: M
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:MULVANNYG2 ARCHITECTURE All contractors and subcontractors are required to be
Contact name:ADRIAN HO licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:1110 112th AVENUE NE jurisdiction in which work is being performed.If the
City/State/ZIP:BELLEVUE WA 98004 applicant is exempt from licensing,the following reasons
apply:
Phone:(425)463.1689 Fax: :(425)463.1889
E-mail:ADRIAN.HO @MULVANNYG2.COM
CONTRACTOR
Business name: ROBINSON CONSTRUCTION CO. BUILDING PERMIT FEES*
Address:21360 NW AMBERWOOD DRIVE (Pfeaxreferto fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP:HILLSBORO OREGON 97124-9321
Phone:(425)453.3380 Fax:( )
FLS plan review fee(if applicable):
CCB lie.:63147
Total fees due upon application:
Amount received:
A
Authorized signature: ,‘....* This permit application expires if a permit is not obtained
Print name: Date: q within 180 days after it has been accepted as complete.
Witi 1/17/10( * Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 10/01/09 440-46I3T(11/02/COM/WEB)
RECEIVED
City of Tigard: Site Work Permit Checklist AUG 2 4 2015
ori
Page 2 -Supplemental Information g61/
CITY OF TIGARD
pLANN1NGIENGINEERINQ
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: 2,200 for tanks cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 13,000 cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) 0 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
n Concrete None
_ _ ❑ Other:
*Total new impervious area including all buildings, 0 (45,500 replaced)
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: _
NI Site Plan with Vicinity Map showing ADA • *Parking(including ADA)and Lighting
compliance Plan
Grading Plan and details II *Landscaping Plan
II Erosion Control Plan and details • Soils Report(if required)
El 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 $.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
$10.76 for each additional$1,000 or
Multi Family R-1 Occupancy 3 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.
t:\Building\Permits\SIT-PermitApp.doc 05/25/2012 2
--511—C;0l51—ooC6/
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: 2(4) 10 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) VA U cu.yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) O cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
NV A ❑ 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 RI *Parking(including ADA)and Lighting
compliance Plan
IGrading Plan and details E. *Landscaping Plan
Erosion Control Plan and details Soils Report(if required)
Ia 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
Building Permit Application
• Site Work FOR OFFICE USE ONLY
114 City of Tigard pat `s Pen na No
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
= Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: Juris 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rotnded 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.
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: $
El Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 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
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State/ZIP: Structural plan review fee(or deposit):
FLS plan review fee(if applicable):
Phone:( ) Fax:( )
CCB lic.: Total fees 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: Date: * Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\SIT-PermitApp.doe 10/01/09 440-4613T(11/02/COM/WEB)
41w-
----Ples.1._„&,0 eux_e__ ,Ac9-622..X
City of Tigard (eernb 2 w/ sat/J /6")1111 II COMMUNITY DEVELOPMENT DEPARTME NT
■
r G n n Building Permit Review — Commercial - With Land Use
Building Permit #: 6/7-0Q-0 / 5 -DOO4/
Site Address: j << ozdku 37' Suite/Bldg#:
Project Name: Cia7b6 Gl/4 _
(Name of commercial business occupying the spa If vacant,enter Spec Space.)
Planning Review VV
Proposal: ,V$f) '7" C' sr 4/1 GU +✓ X ,D (&)09,11, ��)/le krd "l
`'7t0 C -. /i. /. I I I. _ L.
Verify site address/sui .)#exi. . and active in permit system.
land Use Case#:
CUP,. 20/3--
vCZ
14 PlanyMatch Approved Land Use:�/
Y 'te Plan Il ndscape Plan ❑ Other:
/uildin l2 Urba n Forestry Plan Lid Elevation Plan,, g Height: Maximum Height �S Ac Height A- f;--, #"
i': yotnditions Met: ❑ Prior to Submittal VPrior to Permit Issuance
N`
V Business Lice e:
ists: Yes ❑ No,applicant notified to obtain business license
Public Facilit' Improvement(PFI) Permit:
x :
Required: Yes,app cant was notified ��❑ Nod . ,-Appp�lied For: ❑ Yes No, stop intake
Notes: ��fb .�/ ♦ 11• -Iee E GY . /'l.I �F/ i..
. /'..-.• ti Vir -.1/V141. AG. .
Approved by Planning: -R
'' '. ,/f. Date: e?- ?3--/c
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
rAi
Original Submittal Date: 13/ /ii U
Site Plans: # 1
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning P'Engineering Hermit Coordinator 2rBuilding
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: uilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: CA____)(20S-1-4.(-4-ii r Date: ,417/5
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 0204I5.docx
Engineering Review
❑ Actual Slope:
X PFI Permit#: /}E_�� pr,.........,T APL( A-7 L d) .
❑ Conditions Met
A NOT Approved by Engineering: G te—• Date Z .' /, c
Notes: APPi4N t.4) a....)-7- kreer �6e-ms-€i : 1V 14.7) P F ( •vT'
Approved by Engineering: Date:
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
is/Approved,NOT Released: 64,4a vc 4
G% / . /, t a v Date: 3/ _/ ' •
Notes: ‘ --1-€:t.1 ' .
r D� / e -ea (
(/
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: -
K to Issue Permit /
Approved by Permit Coordinator: / Date: / S
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 020415.docx