Permit CITY OF TIGARD SITE WORK PERMIT
' `= COMMUNITY DEVELOPMENT111,
,� ;. Permit#: SIT2017-00005
TtGA R_O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 :rt s Date Issued: 10/02/2017
\`_., SN,..._
jtParcel: 1 S 135DA02400
\O'OS1`4 Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site work for a new 16,327 square feet,32 bed residential care facility. 10/25/18:REPRINTED to correct address
from 11035 to 11045.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
2120 SW CERIS WAY 5987 SE ROBHIL DR
TROUTDALE, OR 97060 MILWAUKIE, OR 97222
PHONE: 530-680-1791 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/02/2017 $1,213.52
12%State Surcharge-Building 10/02/2017 $145.62
Type of Use: COM Plan Review 10/02/2017 $788.79
Class of Work: ALT Erosion Control w/Development 10/02/2017 $236.40
Project Valuation: $190,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 27442 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Yes Accessible Parking: Yes
Fence: Yes
Total $2,384.33
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 obtain a copy of the rules
or direct questions to,OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: +�\—�1( n .,l J� Permittee Signature: (3Y e-n c 1� , 1,
`� Call 503.639.4175 by 7:00 a.m.for the next available inspection date.` ` \'\r l
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.
CITY OF TIGARD SITE WORK PERMIT
III
. COMMUNITY DEVELOPMENT . , . Permit#: SIT2017 00005
fAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Date Issued: 10/02/2017
Parcel: 1 S 135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site work for a new 16,327 square feet,32 bed residential care facility.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
2120 SW CERIS WAY 5987 SE ROBHIL DR
TROUTDALE, OR 97060 MILWAUKIE, OR 97222
PHONE: 530-680-1791 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/02/2017 $1,213.52
12%State Surcharge-Building 10/02/2017 $145.62
Type of Use: COM Plan Review 10/02/2017 $788.79
Class of Work: ALT Erosion Control w/Development 10/02/2017 $236.40
Project Valuation: $190,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 27442 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Yes Accessible Parking: Yes
Fence: Yes
Total $2,384.33
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 obtain a copy of the rules
or direct questions to OUNC by calling 0 •87 or 1.:•0.332.2344.
IssuedByi� Remittee Signature:
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.
CITY OF TIGARD SITE WORK PERMIT
Permit#: SIT2017-00005
2 > COMMUNITY DEVELOPMENT
Date Issued: 10/02/2017
T f C , p D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Site work for a new 16,327 square feet,42 bed residential care facility.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
2120 SW CERIS WAY 5987 SE ROBHIL DR
TROUTDALE, OR 97060 MILWAUKIE, OR 97222
PHONE: 530-680-1791 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 10/02/2017 $1,213.52
12%State Surcharge-Building 10/02/2017 $145.62
Type of Use: COM Plan Review 10/02/2017 $788.79
Class of Work: ALT Erosion Control w/Development 10/02/2017 $236.40
Project Valuation: $190,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 27442 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Yes Accessible Parking: Yes
Fence: Yes
Total $2,384.33
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.2 e: - .'a -
Issued By: -• •.',ee Signature: "r:k,
Ir
Call 503.639.4y 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.
Bu Permit Application
Site Work FOR OFFICE USE ONE\ - —
yd ,5 GT..�-l�/7'L '.� '
City of TigardateiBate/B : i
Penult
No.:
D 'e
IN
in 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R ••
C Phone: 503.718.2439 Fax: 503.598.196Q Date/B : A .i�_ r' y Other Permit: 7 ,,t''►1 iy 7—, .,;
T I G A R D Inspection Line: 503.639.4175 x ' Date Rea i r' loris: : See Page 2 for
Internet: www.tigard-or.gov " C Notified/Method: / Supplemental Information
r
),. TYPE OF W* 7_ REQ111IDED 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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY O1 CONSTRUCTION
work indicated on this application.
0 1-and 2-family dwellingCommercial/industrial Valuation: $
0 Accessory building ❑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 10 35 51 f J1in.A.- 'ivy', New dwelling area: square feet
City/State/ZIP: 17 (241/ ole. el-las Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: a IivE /LIg ,0' 4406— Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
J REQUIRED DATA:COMMERCIAL-USE CHEMIST
,IST
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 the profit for the
I ESCRIPTId 1 OR"WORK work indicated on this application.
/ W 'kiebtVitAl
[//,!_ - Pi ixlt ' P/424-iAA. Ldp" / Valuation: $ 16i0, 07d
v' S.�.D,wv` t/ / at-rte�p_ L—A-A,0544-796�5 4 ^6 Existing building area: square feet
'! l�� ��" '^1"^r J' New building area: square feet
4RQ EItTY OWNER .ENA� „ Number of stories:
Name: ta� M'� Type of construction:
5—qAddress: �47 Gni g_ 1w iiia,. Occupancy groups:
City/State/ZIP: M6 Uwe( Diai 2,V2 Existing:
Phone:1517 CKttii, 1.4412, Fax:( ) New:
APPLICANT' ' :. CO. 'A `PERSON �'
NOTICE _'
Business name: C(Q� �I( ') LL-Ce All contractors and subcontractors are required to be
Contact name: v ��ttF+ �.0u.I S(wt� licensed with the Oregon Construction Contractors Board
6-0
/� under ORS 701 and may be required to be licensed in the
Address: '�It.a Mill Slr 155 jurisdiction in which work is being performed.If the
�� 2 '1i applicant is exempt from licensing,the following reasons
City/State/ZIP:
pot/1,4"o / apply:
Phone:( 7) . (, S,-04...J / I Fax::( )
E-mail: edd ce_¢ rote �T Ar`/
CO C`rOR'
Business name: Pit- tdu ( &tlr724t 1 LJ,L' " ' BUILDING PERMIT FEES*
Address: ni iq t'C'` i rt 155 'v 'Pt. l plan' :vi eejertofeeschedule).
ff 19D�� i o/2- , cl7L42 Structural review fee(or deposit):
City/State/ZIP: -
Phone:(�p7) 2,C5 —�(el Fax:( ) FLS plan review fee(if applicable):
CCB lie.: ' g3V/ Total fees due upon application: i 7y �,1
Amount received: O
Authorized signature: This permit application expires if a permit is not obtained
3,�� within 180 days after it has been accepted as complete.
/� 1 Print name: �j �� / sG(.t, Date: * Fee methodology set by Tri-County Building Industry
vv ,�,v- Service Board.
I:ABuilding\Permits\SIT-PermitApp.doc 10/01/09 440-46I3T(II/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, �� ��L,L
sidewalks, and paving: I 'T 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 7 *Parking(including ADA)and Lighting
compliance Plan
7 Grading Plan and details *Landscaping Plan
Erosion Control Plan and details ❑ Soils Report (if required)
Retaining Structures 2 Fire Line
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans
Va uati t Fee.
(New,Additions or Required at $.0o to$500.00 $51.09 minimum permit fee
Alterations) S . . al $500.01 to$2,000.00 $51.09 for the first$500.00 and
$2.69 for each additional$100 or fraction
Commercial 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.
1:\Building\Peimits\SIT-PennitApp.doc 03/08/2016 2
City of Tigard
71 COMMUNITY DEVELOPMENT DEPARTMENT
r c n x D Building Permit Review — Commercial - With Land Use
Building Permit #: b L j 7-cucx)
Site Address: //C135— 5'W H 13(1t4' Suite/Bldg#: ®v•
Project Name: (j{zoote S i OE /t1 foy q C►ett2e
(Name of commercial business occupying tlil space. If vacant,enter Spec Space.)
Planning Review
Proposal: 'z-ts 3 2, 24.9-.g›-vt.l ø14449 -1CGW'IC t f(-1 ' 7
f l'"-&-- piSiti ,61T
tg Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ❑ Yes 1 No
✓ Land Use Case#: 4 v p 2.0)S— O CCU Z Pf` 2ovt `oi7. T
IB-Plans Match Approved Land Use: 47 SA.V--
14 14
Site Plan X Landscape Plan 0 Other:
Urban Forestry Plan 0 Elevation Plan
rl
1 Building Height: Maximum Height 7, Actual Height :3 3 7, c
Lx Conditions Met: Prior to Submittal 0 Prior to Permit Issuance
i Business License: •
Exists: 0 Yes tgi No,applicant notified to obtain business license
14, Public Facilities Improvement(PFI)Permit:
Required: tc1 Yes,applicant was notified ❑ No Applied For: ' 1 Yes 0 No,stop intake
Notes: 0-66-r .)?J2 c . 4t l 'f fres. o..-)?'S 1"",`-'p 1K)
Approved by Planning: 643.
Date: 2-L3 '' /7
Revisions (after Building Submi a only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 3/01V/.7
Site Plans: # /Of
Building Plans: # 3
Building Permit#: Et—E___nler building permit#above. , _.,-�—
Workflow Routing: L�P ening 2 ngineering L7" 1'ermtt Coordinator [ Building
Workflow Sign-off: -off for Planning(include notes from planning review)
Route Application Documents: LJ Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: /�
By Permit Technician: ez,.."x"",\ Dater 7/"7
I:\Building\Forms\BldgPennitRvwCOM WithLandUse 060116.docx
s
Engineering Review
'Slope at building pad:
/PFI Permit#: .40:g....2,-)re
C�Conditions"Met"prior to issuance of building permit d/
❑ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
O Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes 0 No
LIDA Facility on lot: 0 Yes 0 No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: /4& Date: „si - '
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions"Met"prior to issuance of building permit
proved,NOT Released: ate: _ i__*_ G
Notes: �r/kGC'� IM/�� /X2 C�"�[lf.�
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:
C Fees Entered: Wash Co Trans Dev Tax: es " '"'
Tigard Trans SDC: ❑ Yes ��N/A
.`pParks SDC: Yes /A
K to Issue Permit
Approved by Permit Coordinator: Date: dei n
I:\Building\Forms\BldgPermitRvw COM_WithLandUse 070915.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
III
_ 41
Transmittal Letter
1 („\Ei n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DAN I`JJ L 0A) DATE RE 10 1 i TIED
DEPT: BUILDING DIVISION
MAY 11 2017
FROM: Ari OEZI(n) / 4 4 / L$ bE SG(J CITY OF TIGARD
COMPANY: J3JJ7Y\) a �ri+� BUILDING DIVISION
PHONE: 522 -Q11✓��� BY:8
RE: i) 035 4-Vlc -A) S i 1-2.01---t00
( ite Address) (Permit Number)
( roP jest name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. 2 Revisions: Cowl,1 "TS' (c,i cif 0
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: /Let-,0 GoMPL E'er Skis vS CA C- et:RM S(be#'1S
FK0LJ(1®
FOR 0 'F'ICE USEONLY
Routed to Permit Technici Date: �j + t Initials:
Fees Due: 0 Yes [�] No Fee Description: Amount Due:
$
$
$
$
Special
Instructions:
Reprint Permit(per PE): ❑Yes ❑No 0 Done
Applicant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions_061316.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Site Work SIT2017-00005
Inspection Type: Inspector:
499 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor