Permit 1,4
1 CITY OF TIGARD SITE WORK PERMIT
1r COMMUNITY DEVELOPMENT Permit#: SIT2016-00003
T fG,q RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/26/2016
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD
Project: Lincoln Center Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire line portion of water main replacement. This permit to include erosion control.
Contractor: TITAN UTILITIES LLC Owner: LINCOLN CENTER LLC
11562 SW 175TH AVE BY SHORENSTEIN PROPERTIES LLC
BEAVERTON, OR 97007 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-706-8288 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control w/Development 07/21/2016 $386.40
Permit Fee-Site Work 07/21/2016 $2,156.42
Type of Use: COM Plan Review 07/21/2016 $1,401.67
Class of Work: ALT 12%State Surcharge-Building 07/21/2016 $258.77
Project Valuation: $400,000.00 Plan Review-Fire Life Safety 07/21/2016 $862.57
Info Process/Archiving-Lg$2.00(over 07/21/2016 $42.00
11x17)
Info Process/Archiving-Sm$0.50(up to 07/21/2016 $37.50
Site Specifics: 11x17)
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: No
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: Yes Accessible Parking: No
Fence: No
Total $5,145.33
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may stain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1 :a s .2344.
Issued By: i -e ittee Signature:
ll
Call 503.639.4175 by 7:00 a.m.for the next available inspe, ion d t
This permit card shall be kept in a conspicuous place on the job site until comp':, . ., the pr. ect.
Approved plans are required on the job site at the time of eac t insprc .
iitBuilding Permit Applica ' '"
Site Work I-c i, ?r,;.; P(ltt ()FII( t. I SC 11\1.1
City of Tigard ,
Received
� �YDate/Byt,1/ � / Permit No.:
Ol�dOeir-Ceer,
u 13125 SW Hall Blvd.,Tigard,0�,�74t 1 tin,/,<L)
Plan Revie Other Permit:
Phone: 503.7182439 Fax: 50 3.5.9.8.1960, Date/By:e7
Inspection Line: 503.639.417e )Q U1Nr 1-v$r r Date Rea y: fads B See Page 2 for
I i("A I`1) Notified/Method: Su lemental Information
Internet: www.tigard-or.gov PP
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 0 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: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10220 SW Greenburg Road New dwelling area: square feet
i
.
r, City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Lincoln Center Water Main Covered porch area: square feet
Cross street/directions tojob ste:SW GreenburgRd/SW Washington Square Rd
i g q Deck area: square feet
Other structure area: square feet
I 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(rounded to the nearest dollar)of all
i DESCRIPTION OF WORK equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
Replacement of water main,reconnection of services and fire suppression systems Valuation: $$400,000.00
Existing building area: square feet
New building area: square feet
II!
;:4 PROPERTY OWNER 0 TENANT Number of stories:
i Name:Shorenstein Properties,LLC Type of construction:
! Address:10220 SW Greenburg Road Occupancy groups:
1'1' City/State/ZIP:Tigard,OR 97223 Existing:
I'll' Phone:(503)8483000 Fax:( ) New:
11\ ® APPLICANT ® CONTACT PERSON NOTICE
1 I Business name:Tualatin Valley Water District All contractors and subcontractors are required to be
j 11 licensed with the Oregon Construction Contractors Board
ii Contact name:Peter Boone
I under ORS 701 and may be required to be licensed in the
Address:... jurisdiction in which work is being performed.If the
a City/State/ZIP:1850 SW 170th Ave. applicant is exempt from licensing,the following reasons
t� ty 3 AVfio 1.O , OR. ¶'-'003 apply:
Phone:(503)848-3059 Fax::( )
E-mail:peter.boone@tvwd.org
tli L CONTRACTOR
I Business name:TBD --1"7-rot Tv t.4-ct t t'1 t I.S 1—Le.... BUILDING PERMIT FEES*
I
Address: 1/5/4, -5.(,u '7 515 Au t_..
11
(ease r efer tirfee schedatsl
t ty 6 tR 't'O sO D 2 q-7 ODS Structural plan review fee(or deposit):
� ) City/State/ZIP:
0 Phone:(6&3 70G,.. s as Fax:( ) FLS plan review fee(if applicable):
CCB lie.: �� 1$'l Total fees due upon application: $2,156.00
t 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:Peter Boone Date:1/27/2016 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
.
i
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
0 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:
El 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 0 Soils Report(if required)
❑ Retaining Structures 0 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 3 $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$1,000.00 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 Permils`51T-PennitApp.dm. 12 3005 140-4611 rt I 1 02'C003 WEB)
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engineeringRECEIVED
FEB 17 2016
CITY Or i iuARD
PLANNING/ENGINEERING
TRANSMITTAL
DATE: February 16, 2016
TO: City of Tigard
Permit Center
FROM: Nathan Abercrombie
Wallis Engineering
RE: Lincoln Center
Job No. 1365A
COPIES DESCRIPTION
2 Preliminary set of specifications
3 Preliminary project drawings
COMMENTS
If you have any questions,please call 360-695-7041 or email
nathan.abercrombie(awalliseng.net
Thank you.
215 W 4th Street, Suite 200 Vancouver,WA 98660 Office (360)695-7041 Fax(360) 694-1043 www.walliseng.net