Permit (185) •
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2018-00022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2018
T i t;A R i) g Parcel: 1S134DC03001
Jurisdiction: Tigard
Site address: 11130 SW TIGARD ST
Project: Dirksen Nature Park Subdivision: CHERRY HILL ACRE TRACTS Lot: 6
Project Description: Site work for a new 1,465 restroom facility. Scope of work includes excavation,concrete pathway flatwork,nature
play,curbing and reconstruction of the Fanno Creek trail from Tigard Street to south of the nature play
improvements.
Contractor: COLUMBIA CONSTRUCTION INC Owner: TIGARD, CITY OF
28170 BOBERG RD 13125 SW HALL BLVD
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503-427-0304 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 08/13/2018 $1,249.44
Plan Review 07/12/2018 $812.14
Type of Use: COM 12%State Surcharge-Building 08/13/2018 $149.93
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 08/13/2018 $74.00
11x17)
Project Valuation: $198,000.00 Erosion Control w/Development 08/13/2018 $236.40
Site Specifics:
Excavation Volume: 600 cu.yd.
Fill Volume: 10 cu.yd.
Impervious Surface: 5012 sq.ft.
Engineered Fill: No Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Stom Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $2,521.91
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 callin 503.232.19 7 or 1.80 .332.2344.
Issued By: ! Permittee Signature: 1
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
Site Work r ,``-i r t
FOR OFFICE USE ONLY
City of TigardU v., 9 Da[e 2 018 ReceivedB I /��-' Permit No.: •T `� I �/
13125 SW Hall Blvd.,Tigard,OR 97223 n Review _
Phone: 503.7182439 Fax: 503.598.1960 1 �) £ a`h+t to B : ♦' ) I - I Other Permit:"/ r ii --60, •A
t
T I G A R D Inspection Line: 503.639.4175 1Ib^ r l I; eady/By: Jury: ® See Page 2 for
Internet: www.tigard-or.gov 31.i l l.L.,�, ' s..' ' ` otified/Method: Supplemental Information
- � 'TYPE OF WORT£
REQUIRED DATA:I-AND 2 FAMILY DWELLING
®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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
............ .. ... .........
JOB SITE INFORMATION AND LOCATION e, Total number of floors:
Job site address: 11130 SW TIGARD STREET New dwelling area: square feet
City/State/ZIP:TIGARD,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:N/A Project name:DIRKSEN RESTROOM/NAT PLAY Covered porch area: square feet
Cross street/directions to job site:TIGARD ST AT SW TWIN PARK PLACE Deck area: square feet
ENTER DIRKSEN NATURE PARK AT FANNO CREEK TRAILHEAD. RESTROOM/ Other structure area: square feet
NATURE PLAY IMPROVEMENTS SITED JUST NORTH OF EXISTING SPORTS FIELD REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:1S134DD01000 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.
' Excavation for restroom facility,concrete pathway flatwork,nature play curbing Valuation: $$198,000.00
and reconstruction of the Fanno Creek trail from Tigard Street to just south of Existing building area: square feet
the nature play improvements New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:CITY OF TIGARD Type of construction:
Address:13125 SW HALL BLVD Occupancy groups:
City/State/ZIP:TIGARD,OR 97223 Existing:
Phone:(503)718-2466 Fax:( ) New:
73 APPLICANT 0 CONTACT PERSON NOTICE
Business name:CITY OF TIGARD All contractors and subcontractors are required to be
Contact name:JEFF PECK licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:13125 SW HALL BLVD jurisdiction in which work is being performed.If the
City/State/ZIP:TIGARD,OR.97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)718-2466 Fax::( )
E-mail:jeffp@tigard-or.gov
CONTRACTOR
Business name:COLUMBIA CONSTRUCTION BU1LDINGPERMIT FEES*
Address: 10749 OAK STREET#6 (Please refer to fee achedat0
City/State/ZIP:DONALD,OR.97020
Structural plan review fee(or deposit):
Phone:(503)427-0304 Fax:( ) FLS plan review fee(if applicable): 4.
CCB lic.:199903 Total fees due upon application:4 g'il, i Li
Q Amount received:
Authorized signature:
' This permit application expires if a permit is not obtained
Print name: 1 within 180 days after it has been accepted as complete.
E FF P g'C 1L Date: /9/(J * 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: 600 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) 10 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
El Concrete
❑ Other: n/a
*Total new impervious area including all buildings,
sidewalks, andavin : 5012 sq. ft.
p
r w..
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)
El Retaining Structures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation. ` 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 includin:$2,000.00.
$2,000.01 to$25,000.00 $91.44 for the first$2,000.00 and
$10.76 for each additional$1,000 or
Multi Family R-1 Occupancy 3 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
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 cA R D Building Permit Review — Commercial - With Land Use
Building Permit #: 57-77,26 K—dc)0,a
Site Address: I 1 I4) SW "TIT rot 5.1Y-.�..e - Suite/Bldg#:
Project Name: Oe-S NM-1M V k-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: S i-- perry)
Verify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ Yes A, No
Land Use Case#: CO p 2,013--moo
Plans Match Approved Land Use:
1 Site Plan t Landscape Plan ❑ Other:
Urban Forestry Plan Elevation Plan
V uilding Height: Maximum Heightrb
an FoHeight
Conditions Met: 411K► Prior to Submittal to Permit Issuance
1/4 :usiness License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Public Facilities Improvement(PFI) Permit:
Required: 'Yes,applicant was notified ❑ No Applied For: , Yes ❑ No,stop intake
Notes: Me-of- rryl t hcv c poky - tfis-tAci,N.ce . r
Approved by Planning: ,/(' . Date: 7--¶-1
Revisions (after Building Submittal only) Reviewer 0 Date
Revision 1: ❑ Approved Cl Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal ,P
Original Submittal Date: —7/ /6-
Site Plans: It-7/7//6'///
Building Plans: #
Building Permit#: [ Errt 'building permit#above.
Workflow Routing: ng iEng g—PerffirrOordinatorinator G-ding
Workflow Sign-off: (sign-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:
AinimorBy Permit Technician: I ate: *7////i
I:\Building\Forms\BldgPemiitRvwCOM WithLandUse 060116.docx
Enjineering Review
a
Slope at building pad: G /0/0
❑ PFI Permit#: X)0 T 5a8,.1.7 rrE 0
❑,onditions "Met"prior to issuance of building permitCOA (..t ZL 06 /tT U P01,0 Roma PSE S
D/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:
J / Date: 8/2-//e—
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 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: ❑ Yest/A
Tigard Trans SDC: ❑ Yes to N/A
Parks SDC: ❑ Yes y N/A
?Y9
OK to Issue Permit DApproved by Permit Coordinator: diiate: 6.. 2._/1/v
I:\Building\Forms\BldgPennitRvw_COM_WithLandUse 070915.docx