Permit (153) CITY OF TIGARD SITE WORK PERMIT
2. COMMUNITY DEVELOPMENT Permit#: SIT2017 00004
R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2017
Tt "" 9 Parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: PacTrust Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&f
Project Description: ADA parking lot modification
Contractor: PACIFIC REALTY ASSOCIATES LP Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY#300 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-624-6300 PHONE:
FAX: 503-624-7755
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 03/08/2017 $621.12
Plan Review 03/08/2017 $403.73
Type of Use: COM 12%State Surcharge-Building 03/08/2017 $74.53
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 03/08/2017 $4.00
11x17)
Project Valuation: $65,000.00 Erosion Control w/Development 03/08/2017 $161.40
Site Specifics:
Excavation Volume: 0 cu.yd.
Fill Volume: 0 cu.yd.
Impervious Surface: 0 sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fewer'
Total $1,264.78
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 to enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire questions to • C by calling 503.232.1987 or 1.800.332.2344. -
Issu d By: i / • / Permittee Signature: . VIM' \N-NAA/2"1
r aali !-.46. J
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.
Building Permit Application
GA' ,al ` t i E _O + r +: FOR OFFICE USE ONLY
City of Tigard Received 2
g DateB : ••...11r-r_ Permit No.:6��1•7 D�D
14 13125 SW Hall Blvd.,Tigard,OR 972.« R 8 ?(lit Plan Ree r .0 �; Other Permit:
Phone: 503.718.2439 Fax: 503.598.1'.0 DateB : /p��i� q►�/
Inspection Line: 503.639.4175 ,-1 r Date Read.i:�' - a Juris: See Page 2 for
TIGARD P ! rt ` a ,
Internet: www.tigard-or.gov k 'A a % a F' ,- `�`• Notified/Method: Supplemental Information
�'� '''%'?""
, 6 nl Ili ; e]m s...:- 1 e'� "-.i M� � e,... _ „,,, ,1: /if ` 6 R, "-s,+ I'r,� .`---.,'is.M ���"'`-i
❑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
- _ -7---.7,-�: i , work indicated on this application.
iiiate.;
Valuation: $
❑ 1-and 2-family dwelling
®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
s;
Total number of floors:
s'. Pik -441115"-
t . .l �� a'
�' r =� a "' i� ,::_ ;, i n e.�"Job site address:16100 SW 72°1 Ave. New dwelling area: square feet
City/State/ZIP:Portland,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: lobp128-16100 Ext.Work Covered porch area: square feet
Cross street/directions to job site:SW 72°d Ave.and SW Upper Boones Ferry Deck area: square feet
Other structure area: square feet
11
o l 11, I , _
-
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
equipment,materials,
labor,overhead,
and theprofit for the
' • ' }1 . �% work indicated on this application.
I at _
Exterior Work i N es", A of ?a�rKi (,1 Valuation: $$65,000.00
Existing building area: square feet
New building area: square feet
''1,1-1-''''.4°' 't -' 1:1-- a ` ": 'xi:Ni 4 r - Number of stories:
Name:PacTrust Type of construction: Exterior
Address:15350 SW Sequoia Parkway#300 Occupancy groups:
City/State/ZIP:Portland,OR 97224 Existing:
Phone:(503)624-6300 Fax:(503)624-7755 New:
awl
Business name:PacTrust
Structural plan review fee(or deposit):
Contact name:Leslie Louis
FLS plan review fee(if applicable):
Address:15350 SW Sequoia Parkway#300
Total fees due upon application:
City/State/ZIP:97224
Amount received:
Phone:(503)624-6300 Fax: :(503)624-7755
E-mail:leshel@pactrust.com t :,-.,..---4.,!_i + a a �
_� as q„,-...--„,„ Commercial and residentiallprescriptive installation of
' • t` r is �i roof-to mounted Photovoltaic Solar Panel S stem.
Business name:PacTrust Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:15350 SW Sequoia Parkway#300 Solar Installation Specialty Code checklist.
Permit fee(includes plan review
City/State/ZIP:Portland,OR 97224 $180.00
and administrative fees):
Phone:(503)624-6300 Fax:(503)624-7755 State surcharge(12%of permit fee): $21.60
CCB lic.:153913 Total fee due upon application: $201.60
LAuthorized signature: 10%4 �I/ a y This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 'ie ��,� Datert-• ) * FeeService methodologyBoard. set by Tri-County Building Industry
"
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 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: 0 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 0 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 0 cu.yds.
Retaining structure? (Check one) El Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 0 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 Fees
TYPE OF SUBMITTAL #of Plans Valua`t on: ;;; 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-PermitApp.doc 08/02/2016 2
City of Tigard
:114a COMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R D Building Permit Review — Commercial - With Land Use
Building Permit #: -r v7�oocs 7`
Site Address: lUAI SAN 711G1 JW€/ Suite/Bldg#:
Project Name: PAC-T 12A1
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: xIpel‘ cI - 1U �c / P� FM ��
i
LS
Verify site address/suite# exists and active in permit system.
,0(River Terrace Neighborhood: ❑ Yes No
Land Use Case#: N`Iv l P)-O t,-ob a ii
Plans Match Approved Land Use:
1; Site Plan Nttkandscape Plan ❑ Other:
fJ ..Urban Forestry Plan 'L Elevation Plan 1\i Pc-
Building Height: (J/P( Maximum Height Actual Height
Conditions Met:N`fk ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business License: -- ''
Exists: CI Yes� 'A_❑ No,applicant notified to obtain business license
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified X No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: trAk( 4 111. 1 - Date: 510
Revisions (after Building Submittal o ) Reviewer Date
-Revision 1: LI Approved -- U Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 3�7
Site Plans: # 3
Building Plans: # 3
Building Permit#: 2—Enter building pe t#above.
Workflow Routing: Manning n •tt3g I - _-i •---`a:` ` wilding
Workflow Sign-off: Sl n-off for Planning(include notes from planning review)
Route Application Documents: —Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:By Permit Technician: /. ' Date: 4 t
I:\Building\Forms\BldgPernvtRvw_COM_WithLandUse 060116.docx
Engineering Review
E 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 F. :
Assess Water Quality Fee in-i ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: 0 Yes ❑ No.-
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineeri Date:
Revisions (after ' ding Submittal only) Reviewe 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 ' olicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Se to Applicant:
❑ SDC Fees Entered: Was''Co Trans Dev Tax: ❑ Yes ❑ N/A
Tig. d Trans SDC: ❑ Yes ❑ N/A
Pa s-SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 070915.docx
City of Tigard • BUILDING DIVISION
111111 Over-The-Counter (OTC) Building & Fire Protection System Permit
f , Appointment Checklist
Permit Record#: j 77 a�D11
Contact Name: 1 �G�y
O. Phone#: 67,3— 3 30'�
Business Name: l u„4-74- Appt. Date/Time: j/$' �/O:co
Site Address: /(Q/p0 701'41,4720— Bldg/Suite#:
Project Name:
Project Description: 64714/,;./ moo,.4.--- — ,q D 1} 41,,,\x,,, �i 1
Existing Use: New Use:
MMD Required: Yes 0 No Related Record#: H)-ft o26 i 7—000 *
GENERAL INFORMATION
Class of Work: Group: Type of Construction:
Type of Use: Occupancy Load: Oregon Specialty Code:
I 2014SPECIFICS
Number of Stories: ( Buildin:H-.I ht: Mixed Use:
Number of Dw Units: Number of Bathrooms: I Number of Bedrooms:
BUILDING SQ FT-SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: . Access() Structure: Covered Porch:
Basement: Gara.e: Deck:
Total Square Footage: 041620 Carport: Mezzanine:
SETBACKS
Sideyard Setback—Left Sideyard Setback—Front I
Sideyard Setback—Right Sideyard Setback—Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access.Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: 14... --, Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: BatteryCalcs Provided:
I Ctit cW ,. a-,�
Design Area:
K Factor:
Total Project Valuation: $ CQ5' OCC
$ &Ai. /7.,. Permit Fee—Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2016) $ amu, s 12%State Surcharge
Project Valuation $ 05. 73 Plan Review,Structural
Up to$4,999 $0.00 $ Plan Review,Fire Life Safety
$5,000-$74,999 $90.00 $ it,CC..) Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $224.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $357.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ /(°/.yD Other: ei-DS/D rt) �.tITQDL fr.:-:-g-i.5
Building Staff: $ Other:
Date/Time: $ OTAL FEES DUE
4s/ meq.7S( 4 7/. (c)
I:\Building\Forms\OTC_BUP_FPS_070116.docx f