Permit (15) IN , CITY OF TIGARD SITE WORK PERMIT
!.' COMMUNITY DEVELOPMENT Permit#: SIT2016-0
0012
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/25/2016
Parcel: 1S133AC14500
Jurisdiction: Tigard
Site address: 13285 SW HAWKS BEARD ST
Project: Scholls Ferry Apartments Subdivision: Lot: 63
Project Description: Multiple retaining walls over 4'.
Contractor: HOLLAND CONSTRUCTION INC Owner: GRABHORN, BURTON E ESTATE OF
1111 MAIN ST SUITE 700 14577 SE ANDERSON RD
VANCOUVER,WA 98660 CLACKAMAS, OR 97011
PHONE: 360-597-2036 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/25/2016 $894.73
Plan Review 08/09/2016 $581.57
Type of Use: MF 12%State Surcharge-Building 08/25/2016 $107.37
Class of Work: OTR Info Process/Archiving-Sm$0.50(up to 08/25/2016 $10.00
Project Valuation: $118,795.00 11x17)
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall: Yes
Fire Underground: Accessible Parking:
Fence:
Total $1,593.67
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stat- of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expir- if work not start-: within 180 days of
issuance, o ' k is suspended for more the 180 days. ATTENTION: Oregon law requires yo ; • follow e rules ....ted by the Oregon
Utility tification Ce r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001•'9•. Yo , .y •.t. a copy of the rules
or dir ct questions to OUNC Ili 03.232.1987 or 1.800.332.2344.
Iss d By: /\ ,, G/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. IP
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.
Building Permit Application
Site Work , :- --, /w
> r FOR OFFICE USE oN„,
City of Tigard "'
_ Received
13125 S W Hall Blvd.,Tigard,OR 97223 DateB : y at Permit No.: S f 7120/6—,-00642.
Phone: 503.718.2439 Fax: 503.5 0000 an'e ���11� _M
Inspection Line: 503.639.4175 T Date/B : Other Permit ff��f
TIGARD p '��iOG7/rp
Internet: Www.tigard-or.gov �, Date Read"":7, r�►i, Juris Supplemental
See Page 2 for
q 4- ki, }"s, td 4 y Notified/Method: i(� �"
g ��� PP meatal Information
A." Su le
ilMilf
° p# ` IR QUIRED DATA4 ,
.I� D 2=FAI4IILY,T1WEI.LING
®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
ATE ORY OF CONSTTRUCTION work indicated on this application.
0 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building ®Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
,, ,',, JOBS E 1NFORllLVF1Ol LOCATION
Total number of floors:
Job site address:13285 SW Hawk's Beard Street
New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223
eeitel-1-5 #fes ,9 ; , , Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:435"Sc Scholls Apartment
Cross street/directions to job site:135Th&Scholls Ferry Road Covered porch area: square feet
East of SW 135th Ave,between Scholls Ferry Road and SW Hawk's Beard Street Deck area: square feet
Other structure area: square feet
Subdivision: REQUIRED DAT COMMFRCi4L Jr, `IIECKLIST"
Lot no.: a .
Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1S133AC14500 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
n DESCRIPTION:O1+ VORK work indicated on this application.
Retaining walls over 4'
Valuation: $118,795.00
Existing building area: square feet
New building area: square feet
PROP IRTY OWNER ❑ TENANT
Number of stories:
Name:Keller Holland Tigard Investors,LLC
Type of construction: Retaining Wall
Address:1111 Main Street,Suite 500
City/State/ZIP:Vancouver,WA 98660 Occupancy groups:
Phone:(360)694-7888 Existing:
Fax:( )
New:
APPI
1T;
❑ NTACT.P
Business name:Holland Construction,Inc. tf} IC
All contractors and subcontractors are required to be
Contact name:Kevin Kunishige licensed with the Oregon Construction Contractors Board
Address:1111 Main Street,Suite 700 under ORS 701 and may be required to be licensed in the
City/State/ZIP:Vancouver,WA 98660 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
Phone:(503)610-9048 apply:
Fax::( )
E-mail:kkunishigeghollandpartnergroup.com
CO TRACTOR
Business name:Holland Construction,Inc.
Address:1111 Main Street,Suite 700Ji.Ipia I' TES*
(Please^refertaleetchredule)
City/State/ZIP:Vancouver,WA 98660 , Structural plan review fee(or deposit):
FLS plan review fee(if applicable):
Phone:(503)610-9048 1111 Fax:( )
CCB lic.:193872 I��, Total fees due upon application:
Authorized signature: " f iI�,,' Amount received: ' �• 7 3
This permit application expires if a permit is not obtained
Print name:Kevin Kuniiiige within 180 days after it has been accepted as complete.
Date:8/9/2016
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-Pe►mitApp.doc 10/01/F440-4613T(11/02/COM/WEB)
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 Rewired at
q $.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-&Two-Family Dwelling 3 $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\Permits\SIT-PermitApp.doc 03/08/2016 2
City of Tigard
IN v COMMUNITY DEVELOPMENT DEPARTMENT
T I c A R D Building Permit Review — Commercial - With Land Use
Building Permit #: 7- l [Q _ coo/a--
Site Address: ( 3Z S cvv 1-t-c4w s 6 e i reSuite/Bldg#:
Project Name: - '•
lir
(Name rcialt ess�i[T�yin the s ace./ v tC. Sat
Planning Review ((� J-► U
Proposal: tVl NI 9 `/V Cit,I I s 0 v€
Verify site address/suite# exists and active in permit system.
"fiver Terrace Neighborhood: ❑ Yes No
Land Use Case#: 'D12:2-O ( S ..- c2c)c)c)
,e Plans Match Approved Land Use:
Site Plan ❑ Landscape Plan ❑ Other:
0 Urban Forestry Plan 0 Elevation Plan
—ding Height: Maximum Height Actual Height
--Eenditions Met: 0 Prior to Submittal 0 Prior to Permit Issuance
0 Business License:
Exists: 0 Yes ❑ No,applicant notified to obtain business license
-g—Publie Facilities Improvement(PFI) Permit:
Required: 0 Yes,applicant was notified 0 No Applied For: 0 Yes 0 No,stop intake
Notes:
Approved by Planning: 4/2 0 144 7-- l.? c,Q.St.._ 't Date: 19/ Gi / � ,
Revisions (after Building Submittal only) Reviewer
Revision 1: ❑ Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: g/4/4,
Site Plans: # 3
Building Plans: #
Building Permit#: [ Enter building permit#above.
Workflow Routing: Planning Engineering El-Permit Coordinator -Erguilding
Workflow Sign-off: a Sign-off for Planning(include notes from planning review)
Route Application Documents: 12-Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: (� Date: i/l/A,
I:\Building\Forms\BldgPennitRvw COM_WithLandUse 070915.docx
IlIIIIIIII
Engineering Review
Slope at building pad:
PFI Permit#:
Conditions "Met"prior to issuance of building permit
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 ❑ o
❑ NOT Approved by Engineering: Date
Notes:
Approved Engineering:byE ineeri k`, D _ Date: S ((- g,
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
❑ 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:
!t..),C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes rill /A
Tigard Trans SDC: ❑ Yes MO /A
Parks SDC: ❑ Yes v!llyN/A
OK to Issue Permit/0
l` j
Approved by Permit Coordinator: "(44Date: /
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