Permit (66) CITY OF TIGARD SITE WORK PERMIT
R 2. COMMUNITY DEVELOPMENT Permit#: SIT2016-00021
T f G. R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/08/2016
Parcel: 2S102CC09100
Jurisdiction: Tigard
Site address: 13553 SW PACIFIC HWY
Project: DDHK, LLC Marijuana Facility Subdivision: 2008-058 PARTITION PLAT Lot: 2
Project Description: Site work for a 2,997 sq.ft.commercial building to be used as a retail marijuana facility.
Contractor: K WITT EXCAVATING LLC Owner: DDHK VENTURES LLC
32050 VIEWCREST DRIVE 12604 SW 60TH CT
WARREN, OR 97053 PORTLAND, OR 97219
PHONE: 503-724-4212 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 11/08/2016 $387.28
Plan Review 10/27/2016 $251.73
Type of Use: COM 12%State Surcharge-Building 11/08/2016 $46.47
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 11/08/2016 $30.00
11x17)
Project Valuation: $31,000.00 Erosion Control w/Development 11/08/2016 $107.60
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: 550 cu.yd.
Impervious Surface: 6213 sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking: Yes
Fence:
Total $823.08
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 1.80n 932.2344. ..-------
".•
Issued
.-----
Issued By: �j(�-C`: ( Permittee Signature:`
Call 5��'175�/by 7:00 a.m.for the next available inspec ion date. 41110111
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 FOR OFFICE LSE ONLI
4
•
• Y s"Sk 4
City Of TTigarda M: Received
Date/By: i(! d he, PennitNo.: 57x,„6.--(MAI
13125 SW Hall Blvd.,Tigard,OR ' Plan Re•' - -A (�/
VA
' l: Phone: 503.718.2439 Fax 503.59 r t
Aitsi '% .,Other Permit: /
Date/BY: �/ �� l .���j�G�o —cY'Z+z(-ry
T 1 G A R D Inspection Line: 503.639.4175 (�1t Date Re.. : )f Juris: See Page 2 for
Internet: www.tigard-or.gov �., 41) 7 u a Notified/Method:ed,+; � 17/,,� /6--' 7 7 Supplemental Information
TYPE OF W TO OcA �1 c (OZ
REQUIRED DATA:1-AND 2-FAMILY DWELLING
New construction . r Permit fees*are based on the value of the work performed.
� ' Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ether: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION
❑ 1-and 2-family dwelling C<Commercial/industrial Valuation: $
0 Accessory 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: / 3 7�3 �i� /'nnfir ►�c� >y� New dwelling area: square feet
/
y
City/State/ZIP: f 5 ct 0 >� � L Z 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:', E.E 2�4„Q t ( Covered porch area: square feet
Cross street/directions to job site: fit.._L.., . I"„.-` Deck area: square feet
)\ Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 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
DESCRIPTION OF WORK work indicated on this application.
/`.){r.J IC,C 1-Pt.4 / IA i(ettA Valuation: $
Existing building area: square feet
New building area: square feet
A PROPERTY'OWNER 0 TENANT Number of stories:
r�.
Name: M±er to,..1 74/6 (d(di 7f Type of construction:
Address: e6 e orIc .7-7 U 7 6 l,/ — Occupancy groups:
City/State/ZIP:171 (i l Ti. Z tj ( Existing:
Phone: )to Oz” o --(J f�p Fax:( ) New:
0 APPLICANf,7.' 0 CONTACT PERSON NOTICE
Business name: f.- l ,„A f/0 (d r.r All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
7.--,--
r '- 0,..,_,,, under ORS 701 and may be required to be licensed in the
Address: p tj 6(%7 Z3107 6 ( jurisdiction in which work is being performed.If the
City/State/ZIP: / 6 applicant is exempt from licensing,the following reasons
t'L�qA'-tet apply: —
Phone:(s13) G U d S+-tf 0 Fax: :( )
E-mail: "
7`7 4 Lt.,,,, z_r,..4.A...". c‘rc-i . c.0 M
` l( CONTRACTOR
Business name: f(w/l7 t ,..,/ i LidtSNA,. L L.c BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: ( Z1 4J� �f e‘ Structural plan review fee(or deposit):
City/State/ZIP: yr-n(7 L e, ci ?Os3 ,
3 ) 7�If_f /� ( ) FLS plan review fee(if applicable):
Phone: Fax:
—
CCB lic.: / $ 33r (/).....3/i Total fees due upon application: �d5<<
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: U lull C---9---- Date:,6/Z sr/ k�i * Fee methodology set by Tri-County Building Industry
t ( Je Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/ 2/2016 440-4613T(I1/02/COM/WEB)
I 1"
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: (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 Fee:
,. rc
TYPE OF SUBMITTAL #of Plans Viduitn04: 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.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
M I.
City of Tigard
,1111 N COMMUNITY DEVELOPMENT DEPARTMENT
II
T I G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: `37,2D4, )a
Site Address: /5 Acdc /4�j Suite/Bldg#:
(/
Project Name: ,6k ereS .-L c
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 2/*''P IL)C)r L AguJ ay')7 n1 ,/, cLU1/dim
Verify site address/suite# exists and active in permit system.
'
Il 'ver Terrace Neighborhood: El Yes ❑ No
TA/Land Use Case#: )2)GQ 2)//e— oft)/
Va Plan Match Approved Land Use:
ai Site Plan 0 4,andscape Plan ether:
O{{ rban Forestry Plan 0&levation Plan
f.%uilding Height: Maximum Height Actual Height
El Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance I
Business Licens :
Exists: V Yes ❑ No,applicant notified to obtain business license
/Public Facilit,_ie,j�mprovement(PFI) Permit: I
Required: VJ Yes,applicant was notified El No Applied For: IK Yes ❑ No,stop intake
Notes: 1. l'►61/gpermi;ZDYLYit he n Oc'or A /s�G it cJ c1 `-14/.
Approved by Planning: .- `' __ Date: /(V
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved El Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal /
Original Submittal Date: /c/,y7/!6
Site Plans: # ///3
Building Plans: # j
Building Permit#: [Yfnter building permit#above.
Workflow Routing: lanning ' Engineering irmit Coordinator ui ding
Workflow Sign-off: tgn-off for Planning(include notes from planning review)
Route Application Documents: ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes: 444-6.e. -- -Ce-5 2 /`'f /c1 .--7//6e
By Permit Technician: -- , 5,-- Date: J�j/�.
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_060116.docx
4 ,
Engineering Review
Slope at building pad: /.Z./ 0 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 Appro, •d b Engineeri :: Date
Notes: „e._ ��, .. >�.: ,.I ...----r. .moi -0b l-' 2----., /_ %.•,u ' _._� '
Approved by Engineering:
#./...P Date: `41-4,
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: !AA!i
otes:
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: ElYes N/A
Parks SDC: ❑ Yes N/A
4OK to Issue Permit
Approved by Permit Coordinator: 12,1A, j---- - ' / 4 Date: ///,-//6
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13553 SW PACIFIC HWY, TIGARD, OR, 97223 September 8, 2017 at
11 :14:25 AM
Record Type: Record ID:
Commercial - Site Work SIT2016-00021
Inspection Type: Inspector:
499 Final inspection Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor