Permit (64) CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2016-00019
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2016
TEa''�4t. Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE
Project: Red Rock Center Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Retaining wall for building C-New medical office building.
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 11/03/2016 $516.24
Plan Review 10/18/2016 $335.56
Type of Use: COM 12%State Surcharge-Building 11/03/2016 $61.95
Class of Work: OTR Info Process/Archiving-Sm$0.50(up to 11/03/2016 $22.50
11x17)
Project Valuation: $47,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: No Grading: Yes
Landscaping: Site Prep: Yes
Storn Drains: Retaining Wall: Yes
Fire Underground: No Accessible Parking: No
Fence:
Total $936.25
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 is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the a -go ,-
Utility otification Gen - Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a cop • r
or dir ct questions to OUN • . i a 503.232.1987 or 1.800.332.2344.
Issue By: G� / 42_4641\ Permittee Signature: / f /
_7 `i
-
Call 503.639.4175 by 7:00 a.m.for the next available inspectio- date.
This permit card shall be kept in a conspicuous place on the job site until ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
tr` *wilding Permit Application
Site Work FOR OFFICE USE ONLY
Ee
} "' L1L PermitNo.: ( j6_ l cr1,111h 111 13125 SW Hall Blvd. Ti ard,OR 972g w c
Phone: 503.718.2439 Fax: 503.598.1 Date/By: 4 ' I �1 ` Other Permit: �_0«.-ea 7'0
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: ko
Jure See Page 2 forInternet: www.tigard-or.govotified Method: iJ � I Supplemental Information
OCT� �6
Eitet rNAI
TYPE OF 'MY OF TIGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 1DIVISIO ' Permit fees*are based on the value of the work performed.
IPI 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 CONSTI;UCTION work indicated on this application.
ElI-and 2-family dwelling �'Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 21 15 i W 7(044` j4'J.t. New dwelling area: square feet
City/State/Z1P: 1, ! QQ. c.k 7 27-3 Garage/carport area: square feet
Suite/bldg./apt.no.: V Project name: 11.4.A RAtt,C" Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:±C QMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
SiT4.- Ie.. ihsand Wa�l� p‘,,,,, k. C.WGKlot.'ksw%5 Valuation: $ �'�r QUO
Ilk Existing building area: square feet
New building area: square feet
ig PROPERTY'OWNER 1 , r 0 TENANT Number of stories: s
Name: b0 F-Iy : I 1 t,J Pvs,4.4 lit. Type of construction:
Address: 9(fig b t6oto..L, Ra Occupancy groups:
City/State/ZIP: N Cx..)6c.,c, 0 it '17 1 2.
ck 1Existing:
Phone:(' Q3) 3 $y - 2:1-3 ] Fax:( ) New:
0 APPLICANT CONTACT PERSON NOTICE
Business name: pn n� / 4,,
Yvt W4Ci'f7 1'Y1f,�,.d" lsS"N`'�`'-t4 " All contractors and subcontractors are required to be
Contact name: (>76w�. licensed with the Oregon Construction Contractors Board
o
IU
under ORS 701 and may be required to be licensed in the
Address: 6,3(. 5 //8,,(,,A) apse,,, t,,,X� IU 5 jurisdiction in which work is being performed.If the
City/State/ZIP: <.. sW c.$ CA, 9,7 03 5 applicant is exempt from licensing,the following reasons
apply:
Phone:(O3) 1,t7,, 5(7-jct Fax::( )
E-mail: 4yl C..@ eirn m Rotikk'Q i' �v% .U Y
.c. CS.)
CONTRACTOR
Business name: LMMZK'C 9\..,,•„, Ste `�+ BUILDING PERMIT FEES*
Address: C3O S S 1..) A Ssi-, (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP: t,,,.S, V S
FLS plan review fee(if applicable):
Phone:(Sol)) 476,- coG34.( Fax:( )
CCB lie.: ?I-�a Total fees due upon application:
Amount received: C
Authorized signature: )
0-_ Exc7 This permit application expires if a permit is not obtained
7�"^'• within 180 days after it has been accepted as complete.
Print name: !( S .71.0-Y` Date: W/ S/ 1(a * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(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
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Vaivationl» Permit Pee:
(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\Pernits\SIT-PermitApp.doc 08/02/2016 2
City of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 A R D Building Permit Review — Commercial - With Land Use
Building Permit #: r /
Site Address: f.2. 115- ( J 70' /7 Suite/Bldg#:
Project Name: 44:7" - (e41-71e,--
(Name
er/7 ,—(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: ((Ec.,L e 7'' (-tc..nST
a-Verify site address/suite# exists and active in permit system.
El River Terrace Neighborhood: ❑ Yes No
❑ Land Use Case#: 7> ( 2-0/0- f=C C'C) 2 / / L( C)0 2. ?
fa Plans Match Approved Land Use:
Site Plan ❑ Landscape Plan ❑ Other:
❑ Urban Forestry Plan Elevation Plan
/1.44-0 Building Height: Maximum Height Actual Height
/G -Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
19(Public Facilities Improvement(PFI) Permit:
` Required: ❑ Yes,applicant was notified ❑ No Applied For: IK Yes ❑ No,stop intake
Notes: t{4 .
(
Approved by Planning:
( Date: (C"f g—(6
Revisions (after Building Submittal only)( r Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: /(}/��7`',+
Site Plans: #
Building Plans: #
Building Permit#: Enter building��perm��it#above.
Workflow Routing: ala-n-ning Lk�:nglneering L'frPermtt Coordinator ming
Workflow Sign-off: Er‘-off for Planning(include notes from planning review)
Route Application Documents: DC.f ulding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: � - Date: ifetfieho
I:\Building\Forms\BldgPermitRvw_COM_WithL.andUse 070915.docx
s
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 ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: 4Z cJ Date: /z7--ft—/Z.
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:
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
'OK to Issue Permit
Approved by Permit Coordinator: Date: /404V/4'
I:\Building\Forms\B1dgPennitRvw_COM_WithLandUse O70915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Site Work SIT2016-00019
Inspection Type: Inspector:
499 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor