Permit (39) CITY OF TIGARD SITE WORK PERMIT
1111
s COMMUNITY DEVELOPMENT Permit#: SIT2016-00005
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2016
T t K3 Lf�, D g Parcel: 2S106DB23700
Jurisdiction: Tigard
Site address: 17390 SW SABRINA AVE
Project: River Terrace Northwest Swim Center Subdivision: RIVER TERRACE NORTHWEST Lot: X
Project Description: Site work for new swim center.
Contractor: WILLIAM LYON HOMES INC Owner: ADLV LAND HOLDINGS LLC
109 E 13TH STREET BY FORSUM, MICHAEL
VANCOUVER, WA 98660 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 360-695-7700 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/25/2016 $338.92
Plan Review 05/25/2016 $220.30
Type of Use: COM 12%State Surcharge-Building 05/25/2016 $40.67
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 05/25/2016 $10.00
11x17)
Project Valuation: $25,000.00 Erosion Control w/Development 05/25/2016 $80.70
Site Specifics:
Excavation Volume: 32 cu.yd.
Fill Volume: 1432 cu.yd.
Impervious Surface: 12400 sq.ft.
Engineered Fill: Soil Report Required:
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking:
Fence:
Total $690.59
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 ions to a UNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: !� 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.
J 1.
It e
Building Permit Application
Site Work RECEIVED ►:t)ll (ll l:lt 151 t)V
Cityof Tigard �.•. Permit No..
131SW Hal Blvd.,Tigard,OR 97223 MAY 12 2016 Date'B �2 /' �� �'iC/ "o ) Oas
Plan Review;�;
Phone: 503.718.2439 Fax: 503.598.1960�� Date/B : gW/�11 Other Penni j(��/6�35(p
i 1,, .`i i Inspection Line: 503.639.4175 CITY OF 1IGAI7D Jori:Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Noti . .lhtethod: • � �� �., � Supplemental Information
BUILDING DIVISION �''�'*Y° �-
TYPE OF WORK REQUIRED DA A:1-AND 2-FAMILY DWELLING
Q New construction 0 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 0 Commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder /Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 7 3?0 Sr,O S#}Q/e,AJ,9- New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 2Jb'/L 72 N027-md ES jrovered porch area: square feet
Cross street/directions to job site: KJ/n7 CEA/ — Deck area: square feet
4e%✓ ode 743,-..-0e.• Siitli,.-7 (1:109 4, Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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
DESCRIPTION OF WORK work indicated on this application.
/� Valuation: $
.- %ic.. /1--;‘,.,-/L '73%! _...<4.,;_,,, /„�iifr / Yrs.,/i �S_�G?�'YJ_
464 ,<cac..is's� J Existing building area: square feet
—
New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: A.,4,-,,diat. 46p11111 ( aortal/Pro aortal/Pro Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
0 APPLICANT CONTACT PERSON NOTICE
Business name: ems/, 1/42,./ , ) All contractors and subcontractors are required to be
�
i licensed with the Oregon Construction Contractors Board
Contact name:
C j4/�-C �c'' under ORS 701 and may be required to be licensed in the
le—
Address: /0 1 4. /3 sem- jurisdiction in which work is being performed.If the
City/State/ZIP: /41,,,7, �"v i��� d/
l�/� et, applicant is exempt from licensing,the following reasons
apply:
Phone:( )tG 45- 77,„O Fax::(31‘0 el lefe y3
E-mail:
CONTRACTOR
Business name: 4.071"---------ifir.--yeir,e,
it ( I-44 n. 1.-Y0/3/4v41 /IJ a BUILDING PERMIT FEES*
Address: �' .As .lir- Meese refer re bite schedule)
7 Structural plan review fee(or deposit):
City/State/ZIP: be.A 4,1.- y G
FLS plan review fee(if applicable):
Phone:( 0 0,e.7,�'),�, Fax:Craw) �9 v yvy,
CCB lic.: - q7 Total fees due upon application:
Amount received:
Authorized signatu /' This permit application expires if a permit is not obtained
�/ f�i� within 180 days after it has been accepted as complete.
Print name: A7^ A.,4 6/4, Date: r' ., 6 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-Permit App.doc 10/01/09 440-4613T(II/02/COM/WEB)
A
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: 32 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 1'-00 cu. yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) \'- 'j..,. cu.yds.
Retaining structure? (Check one) 0 Rock
❑ CMU
0 Concrete
® Other: Modubv Bock ;1-oac+L-o4
*Total new impervious area including all buildings,
sidewalks,and paving: 12,lop 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 0 *Parking(including ADA)and Lighting
compliance Plan
❑ Grading Plan and details 0 *Landscaping Plan
❑ Erosion Control Plan and details ❑ Soils Report(if required)
•
❑ Retaining Structures 0 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 3 $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-PennitApp.doc 03/08/2016 2
r .
City of Tigard
1111
a COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Budding Permit Review — Commercial - With Land Use
Building Permit #: �'/%o2p/(a — DDaas''
Site Address: /7390 ?/C) Al2A1914 Suite/Bldg#:
Project Name: ,e!'�,r,.r- 77' ffoeZ AJ i kvK27L _QZZ244 ,CQ7--
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: t ggc) -Steiivt cin? (S> jt 90r,C.)
eerify site address/suite# exists and activ$41 permit system.
ver Terrace Neighborhood: 1a Yes ❑ No
0fLand Use Case#: P,���O/ �S _sy, /S '- )a9
ICJ Plays Match Approved Land Use:
101 Site Plan $Landscape Plan $ Other:
/- Urban Forestry Plan $ Elevation Plan
Building Height: Maximum Height NIA Actual Height
0 onditions Met: 1=1 Prior to Submittal ❑ Prior to Permit Issuance
Business Li
xists: cePnf�:
Yes ❑ No,applicant notified to obtain business license
ILJ Public Faciliti Imp rovement�' �F Permit:
Required: Yes,applicant was notified LI /No Applied For: Yes ❑ No,stop intake
Notes: �-�JCl ag 1,. -Q ) QJ = Of' 4) /lh;f 7'- , c-/, j,y'e
kali' i- n� c-- 4 s' deed /
Approved by Planning: / • Date: SIP/1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved Cl Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: -57%'2//�
Site Plans: # 3
Building Plans: #
Building Permit#: 'Enter building permit#above.
Workflow Routing: Ki-Planning C`-Pngineering 1ermit Coordinator C4-1<ilding
Workflow Sign-off: 0-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: Date: os7-Ag
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse_070915.docx
.
Engineering Review
Slope at building pad:
❑ PFI Permit#:
El Conditions "Met"prior to issuance of building permit
El Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes El No
❑ NOT Approve bir Engineering: Date
Notes: d�.7s ld 'I®(� _.
Approved by Engineering: /1/ J) Date: 5/ A
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes El N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes El N/A
OK to Issue Permit
Approved by Permit Coordinator: 044 Q . townt ,..) Date: S - I $ I b
o (r1 of C o n 1'1 e c-f- - u S a se,
SDCs en-4ertd ease I��,� w; (( be re J; e „4,c po Ss ;bye,
kegivEzti. n-eed Qd .
1.•\Building\Forms\BldgPermitRvw_COM_W ithLandUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17390 SW SABRINAAVE, BEAVERTON, OR,
97007
Record Type: Record ID:
Commercial - Site Work SIT2016-00005
Inspection Type: Inspector:
499 Final inspection Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor