Permit (8) CITY OF TIGARD SITE WORK PERMIT
1111
COMMUNITY DEVELOPMENT
Permit#: SIT2016-00006
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2016
Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE
Project: Red Rock Center Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Building C-Site work for a new medical office building shell.
Contractor: EMMETT PHAIR CONSTRUCTION Owner: TIGARD TRIANGLE PARTNERS LLC
16650 FIR LANE 18187 SIERA DR
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034
PHONE: 503-572-8606 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/22/2016 $3,054.42
Plan Review 05/19/2016 $1,985.37
Type of Use: COM 12%State Surcharge-Building 08/22/2016 $366.53
Class of Work: NEW Plan Review-Fire Life Safety 08/22/2016 $1,221.77
Project Valuation: $600,000.00 Info Process/Archiving-Lg$2.00(over 08/22/2016 $52.00
11x17)
Erosion Control w/Development 08/22/2016 $536.40
Site Specifics:
Excavation Volume: 1530 cu.yd.
Fill Volume: 720 cu.yd.
Impervious Surface: 37000 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: Yes
Fire Underground: Yes Accessible Parking: Yes
Fence:
Total $7,216.49
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 Notif _- -nter. 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%uestions to 0 C b •Iling 503.232.1987 or 1.800.332.2344.
_a
Issued ;y;
1i i 1 Permittee Signature:
F
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.
I
Building Permit Application
Site Work FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
1,1 _ '� 13125 SW Hall Blvd.,Tigard,OR 972 n Date/B : <�� ra
Permit No.: ri ,
Phone: 503.718.2439 Fax: 503.598.1960 'Z�16 mi
Plan Revie '0
MAY 1 Date/B pj'� MOt. �]� Other Permit: Aj •
1-1(s`ARPS Inspection Line: 503.639.4175 Date Re:. �:�! pli .Li • '
Internet www.tt and or ov OF ,u See Page 2 for
g g / 1) Notified/Meth,.:
CITY �'V , , J/ j! Supplemental Information
^'� `"= T Eai : 8i, s. ;: `, x ".^' vUIREb Ti 1-�2 =+:` ' �` 7
�:� �'�- I'<�153I>€c3i`�21:t.r�14r_
®New construction El Demolition Permit fees*are based on the value of the work performed.
Addition/alteration/replacement
Indicate the value(rounded to the nearest dollar)of all
0 Other: equipment,materials,labor,overhead,and the
profit for thei VA GOY OF R'gfi eff6 � work indicated on this application.Fl, x , , I
�❑ 1-and 2-family dwelling W Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 1:1Other: Number of bathrooms:
-
JOSiT 'WOOF 1st'11I
�- - 4nv vB r n, l9 O 1*- LQ00Tf)I - Total number of floors:
Job site address: 12115 SW 70th Ave New dwelling area: square feet
City/State/ZIP: Tigard, OR Garage/carport area:
square feet
Crossbldg./apt.no.: I Project name: Red Rock Center Pad C Covered porch area: square feet
cross street/directions to job site: 72nd Ave and Dartmouth Street
Deck area: square feet
Other structure area: square feet
kl'
REQUIR.E DATA Q--I , tC . SE CH C i 'Subdivision:
I Lot no.: Permit fees*are based on the value of the work performed.
,,'`..., Tax map/parcel no.: MAP 25101 AB, TL0010 Indicate the value(rounded to the nearest dollar)of all
a
,
Tr equipment,materials,labor,overhead,and the profit for the
rte' s j D1 S tIPTIOI o S?IttORK _ f
v t work indicated on this application.
11.4
Site work for a 21,000 SF medical office building shell Valuation: $ $600,000.00
Existing building area: square feet
i
--,w..,,,, New building area: 21,000 square feet
eV i" ^OWNE1> •w t ;Q '1 x xr;
�1n ? .r Number of stories: 2
Name: DF Development, LLC Type of construction: VB
Address: 908 Deborah Road
Occupancy groups:
City/State/ZIP: Newberg, OR 97312
Existing:
Phone:(503 )348-2237 Fax ( )
New: B
c'•G n Q APP El CO fiTA,CT PERSON; .:
a . ._= wv_ G iy a
Business name: Anderson Dabrowski Architects, LLC
All contractors and subcontractors are required to be
! Contact name: Jon Anderson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1430 SE 3rd Ave, Suite 200
jurisdiction in which work is being performed.If the
City/State/ZIP: Portland, OR 97214 applicant is exempt from licensing,the following reasons
Phone:(503 239-7377apply:
) Fax::(503)239-7327
E-mail:
:1 R7i• -� • 1 t' - 440fir"• s `.,iy,,% s:-a:
Business name: Emmett Phair Construction
F.
Address: 16650 Fir Lanett * ; „a
Structural plan review fee(or deposit):
City/State/ZIP: Lake Oswego, OR 97034
FLS plan review fee(if applicable):
Phone:(503 )572-8606 i Fax:( )
CCB lic.: 57' 7 Total fees due upon application:
Authorized siy +tore: I 0 'ailAmount received:
A
! This permit application expires if a permit is not obtained
Print names b if . , i%4 I Date: 6 'O j� I µ►thin 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
I:\Building\Permits\SIT-PermitA dos 10/01/09 Service Board.
PP• 440-4613T(11/02/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.
/53e)
Excavation Volume: - - cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.)
720 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) Z. 9 cu.yds.
Retaining structure? (Check one) Rock
CMU G *417
Concrete
El Other:
*Total new impervious area including all buildings,
sidewalks,and paving: '.. 7 n D d
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
0 Grading Plan and details 0 *Landscaping Plan
R
Erosion Control Plan and details ❑ Soils Report(if required)
Retaining Structures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation: ,
(Hew,'Additiona or $5109 Permit Fee;
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
Commercial 3 $2.69 for each additional$100 or fraction
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
One-&Ttyo-Family Dwelling 3 $25,000.00.
$25,000.0I 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
t] ( � f $5.38 for each additional$1,000.00 or
( -ill
/ fraction thereof to and including
i 37 5— $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
3 7/ 0 Q 0 fraction thereof.
I:\Building\PermitsiSlT-PennitApp.doc 08/02/2016 2
1111 City of Tigard
C
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 ca R D Building Permit Review — Commercial - With Land Use
Building Permit #: ; 7' 0 /(c,—COCOG
Site Address: /cQ//C-- S'Zt-) . „j P Suite/Bldg#:
Project Name: i.?e_r) I204 guie-d/ uo- c
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review _�
Proposal: "1eyv �/i COU SF' /' _R/ ` e- Ge ‘44.41n 'Ae,
a Verify site address/suite# exists and active in permit system.
ever Terrace Neighborhood: ❑ Yes lig No
L nd Use Case#: 4'01KZ O/0_OCAn0 2- v/i- 2 c.i q-ocr 3
p• Plans Match Approved Land Use:
Site Plan Landscape Plan ❑ Other:
/. Urban Forestry Plan elevation Plan
,2YBuilding Height: Maximum Height '%3— Actual Height 3 G
./Conditions Met: . 1 Prior to Submittal 1:] Prior to Permit Issuance
tsusiness License:�
Exists: I2Yes ❑ No, applicant notified to obtain business license
ublic Facilities Improvement(PFI) Permit:
Required: Yes,applicant was notified ❑ No Applied For: es El No,stop intake
Notes: FFT d3ri T') 87 /)rk E-G-
Approved by Planning: ..` Date: =/ ®l ‘,
Revisions (after Building Submitta . Reviewer Date
Revision 1: ID Approved El Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: M it- 7 /9/ 20/43
Site Plans: # o 0
Building Plans: # 3
Building Permit#: r building permit#above.
Workflow Routing: & nig —gineering t Coordinator ,
ing
Workflow Sign-off: off for Planning(include notes from planning review)
Route Application Documents: : original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date:
37/1)/6
I:\Building\Forms\BldgPernritRvw_COM_WithLandUse 070915.docx
Jr
Engineering Review
El Slope at building pad:
El PFI Permit#:
El Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat(not typical on SDR/CUP)
El Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes El No
Assess Water Quantity Fee in-lieu: El Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes: grip yfvlal al AG n GD7)GI i'"Id/'yi /1Jlei /92' f
11 �/d
Approved by Engineering: sari ' a),"/, Date: ��y
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
❑ 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 /A
Tigard Trans SDC: ❑ Yes (N/A
Parks SDC: El Yes N/A
K to Issue Permit
Coordinator: a 5/7,6'
b Permit Coord Date:
- Approved y
I:\Building\Forms\B1dgPernutRvw_COM_W ithLandUse_070915.docx