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Permit Support Document (19) Building Permit Application 0 I 0 /�'b// c Site Work pr:t - -- FOR OHF ICE ISEOyL1 City of Tigard U 2 Receivedt ,/A/ !/� PermitNo.� � �^�/i1�� III13125 SW Hall Blvd.,Tigard,OR 97223A G 7 C 013 Plan R view ( (/v ■ Phone: 503.718.2439 Fax: 503.598 1,96Q Date/By: ') — other Permit: T I<_ \j,n Inspection Line: 503.639.4175 ,, Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov F'- ;,j Notified/Method: Supplemental Information , ,2 t t `''`® � ,i`33 1,11 ' { �A , .i t7, `€ „,---,7,-.fe I :.F B «: t,'„i, - , 0 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 ❑Other: equipment,materials,labor,overhead,and the profit for the E g '' ;4' SEE 11Kf O ! • �g ,3 - work indicated on this application. ❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: SNA ❑Accessory building 0 Multi-family Number of bedrooms: 0 ❑Master builder ®Other:Utility Number of bathrooms: 0 ' €' y i�I f �� cAIL Total number of floors: 0 Job site address:17005 SW 92ad Ave New dwelling area: 0 square feet City/State/ZIP:Portland,OR 97224 Garage/carport area: 0 square feet Suite/bldg./apt.no.: Project name:Tual9fin rota..a�,tnr and Sinhnn impr.axn.+.a.+tc. Covered porch area: 0 square feet Cross street/directions to job site:SW 92nd Ave at Cook Park Deck area: 0 square feet Other structure area: 0 square feet 1 EQ � t 's,� tf'I IitCIATS V '1'' Subdivision:See attached list of lots. 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 = ri SCR ON ''”' ' 4--kz, work indicated on this application. Excavation and restoration work related to the construction and replacement of sanitary sewer Valuation: $NA C Y 0/ pipeline,along with associated siphon structures,manholes,mainline connections,service lateral Existing building area: 0 square feet connections,and surface restoration to preexisting conditions. New building area: 0 square feet ,,., � t a� --..---:-c,-,� amu . z. Number of stories: Name:Clean Water Services Type of construction: Sewer Utility Address:2550 SW Hillsboro Hwy Occupancy groups: City/State/ZIP:Hillsboro,OR 97123 Existing: NA Phone:(503)681-3600 Fax:( ) New: NA a , " " O� r � Business name:Clean Water Services All contractors and subcontractors are required to be Contact name:Wade Denny licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address:2550 SW Hillsboro Hwy jurisdiction in which work is being performed.If the City/5tate/ZIP:Hillsboro,OR 97123 applicant is exempt from licensing,the following reasons apply: Phone:(503)681-3600 Fax::( ) E-mail:dennyw@cleanwaterservices.org Business name:M.A.Mortenson ;4,,,,„ J I R I .s4 it .Address:700 Meadow Ln N t �, City/State/ZIP:Minneapolis,MN 55422 Structural plan review fee(or deposit): FLS plan review fee(if applicable): Phone:(503)400-0638 Fax:( ) CCB lic.:46955 Total fees due upon application: Amount received: Authorized signature: /52,4i-, C, This permit application expires if a permit is not obtained Date: , / within 180 days after it has been accepted as complete. Print name: I'�4'x'9 0I d C k r7 j'/� I// * 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: 13663 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) ❑ Rock ❑ CMU ❑ Concrete ® Other: NA *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: LI 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 SVEMITTTAL #of Plattsfr Luit Permit Fe (Ne.S"j Additions "" Required at $.00 to 500.00 $51.09 minimum.ermit fee Altetatio ..' Submittal $500.01 to$2,000.00 $51.09-forthe 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 ■ li 111 Site Work Permit Application Plan Submittal Requirements 1 I v A R D Commercial, Multi-Family and One- &Two-Family Dwellings A site work permit is required for all commercial projects including new buildings, additions, accessory buildings larger than 120 square feet,modular structures and multi-family R-1 occupancies. A site work permit is required for excavation, fill,grading,paving,retaining walls, fire hydrants and fire department access on private property for work on individual lots not covered under the subdivision development. Note: A separate "plumbing"permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. Please see the Site Utilities -Plumbing Permit Application for plan submittal requirements. 1. SITE PLAN and vicinity map (fully dimensional,drawn to scale) showing the geographic location labeled with: A. ® map& tax lot# ® project name ® site address ❑ suite number ❑ zoning ® applicant name ® applicant phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads (drawn to scale) with project location. 2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only. All details listed below shall be incorporated into the plans: A. Site plan showing: 1) Required parking spaces and driveways. 2) A route, accessible to persons with disability,leading from the public way to an accessible building entrance. 3) Accessible parking spaces and adjacent access aisle connecting with the accessible route. 4) Curb ramps along the accessible route, curb, sidewalk and gutter. 5) Finish grade elevations along the accessible route. B. Topographic survey plan showing grade elevations crossing the entire site. C. Overall grading plan. D. Utilities plan showing: 1) Fire hydrant location and pipe size if on private property. 2) If the building is to be protected with an automatic fire sprinkler system, show location of the water service vault and the fire department connection (FDC) within 70 feet of a fire hydrant. 3) Size of underground water service for the sprinkler system. E. Erosion control plan complying with the requirements of the Clean Water Services (CWS) agency showing. 1) Silt fence locations. 2) Bio-filter bags/other approved barrier material surrounding catch basins. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 3 • 3) Illustrations detailing the correct installation of the silt fencing and catch basin protection. 4) Any other measures to ensure compliance with CWS standards. F. Landscaping plan. 3. ADDITIONAL REQUIREMENTS: A. Soils (geotechnical) report. A soils report is required for new buildings and additions to contain the following: 1) The report shall address the potential of soil liquefaction and instability (OSSC Sec. 1804.2). 2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1). 3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805). B. Fire flow and hydrant worksheet. C. Plan review deposit based upon project valuation. I:\Building\Permits\SIT-PermitApp.doc08/02/2016 4 Site Work Permit City of Tigard Project: Tualatin Interceptor and Siphon Improvement Project No. 6493 (CUP2018-00005, SLR2018-00004) Tax Lots in Construction Area Tax Map# Tax tot IDis 2S114AC 700 2S114A 1500 2S114AD 100 Tualatin River TOWNSHIP, RANGE,SECTION Township 2 South, Range 1 West,Sections 14 Kennedy/Jenks Consultants 7 February 2018 � ,� PROA?37r- Memorandum , sC y 41 ,Ikl- dAA., tip To: Sarah Betz- DEA OREGON co 11° JULY 21 1 °' sk From: Heather Stephens— Kennedy/Jenks P_• Consultants EXPI�.:77 N ©Ag E'to(t/1; Subject: No Rise Documentation for Upper Tualatin Interceptor K/J 1776025.00 The Upper Tualatin Interceptor serves King City, Sherwood, Tigard, and Tualatin, conveying flow from the Durham Basin to the Durham Wastewater Treatment Plant. The existing interceptor is being upgraded to address existing capacity deficiencies in the Durham Basin and to accommodate planned growth within existing growth boundaries. The project will replace an existing buried pipeline with a larger buried pipeline. The project will not change the existing ground elevations, resulting in no net cut or fill and no fill in the floodplain. Following construction, the final ground surface will be restored to pre-construction elevations. One existing appurtenance (the King City siphon outlet structure) is currently located three feet above grade and will be modified to lower the top of the structure to at-grade elevation. q:Iprojects1201711776025.00-cws_upper_lualatin_interceptor111-pennits111.01-pennitapslnorisememo.doc 0 Kennedy/Jenks Consrdtants,Inc. Tualatin Interceptor and Siphon Improvement Project No. 6493 Construction Estimate Open Trench Work Environmental Protection $ 19,294 Trench Excavation&Backfill $ 2,781,447 Manhole Installation $ 131,250 Pipe&Manhole Materials $ 869,587 Trench&Easement Restoration $ 730,682 Dewatering $ 46,535 Total Open Trench Work $ 4,578,795 Trenchless Work Microtunneling and Pipe Installation $ 3,872,500 Total Trenchless Work $ 3,872,500 Total Cost of Project $ 8,451,295 (Within City of Tigard) City of Tigard 71 ~ COMMUNITY DEVELOPMENT DEPARTMENT i T 1 G A R D Building Permit Review — Commercial - With Land Use Building Permit #: JTTNO/f — 0®c9- ' Site Address: /7j0S- Q/,[j 9J Suite/Bldg#: Project Name: —7742-Mrt_ jp,/er A t' ...oft Ge �a AA n //Prbvi-eih en 7c• (Name of commercial business occ pying the space. If vacant,enter Spec Space.) Planning Review Proposal: Ea/t?,l/a 'd _n ei f',,,, Atkrt___. A9or--L Y Bd Verify site address/suite# exists and active in permit s stem. A' ': er Terrace Neighborhood: CI Yes Or No Pi Land Use Case#: Ot/�.2vie, COO Or; ,S7LPo-0i - OO/ ❑ Plans Match Approved Land Use: ❑ Site Plan ❑ Landscape Plan ❑ Other: ❑ Urban Forestry Plan ❑ Elevation Plan \ uilding Height: Maximum Height Actual Height ❑ Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance ill `iusiness License: xists: ❑ Yes ❑ No,applicant notified to obtain business license IBJ Public Facilities m rovement F Permit: Required: Yes,applicant was notified ❑ No Applied For: Yes ❑ No,stop intake Notes: /k4i ��-- Gird USE- DII&74v ""*Aa? 4-a-ti -2L1,20(e Approved by Planning: .07-� -' Date: 2-7-j' Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: i /1 Site Plans: # Building Plans: # Building Permit#: nter building permit#above. Workflow Routing: Tanning 117-engineering Permit Coordinator nBuilding Workflow Sign-off: ign-off for Planning(include notes from planning review) Route Application Documents: - 1-1$uilding: original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit"Technician: ,44^44��/�//,(,,22 Date: 0,4 7///' I:\Building\Forms\BldgPermitRvwCOM WithLandUse 060116.docx Engineering Review CS ope 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: CIYes CINo _ ��-NOT Approved by Engineering: MI k tz_ %A-,► Date Notes: (l' --r//, t) I,cJ, 12_ c?72- 1%iLri/L STna P sd'v 72,( 5e? K- f t -i M •L-g, L7-- Approved by Engineering: Date: 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: r 146�-A e G Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: /SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes / N/A Tigard Trans SDC: ❑ Yes N/A Parks SDC: ❑ Yes 7N/A ❑ OK to Issue Permit Approved by Permit Coordinator: Date: I:\Building\Forms\BldgPermitRvw_COM_W ithIandUse_070915.docx Albert Shields From: Albert Shields Sent: Tuesday, August 28, 2018 6:53 PM To: 'dennyw@cleanwaterservices.org' Cc: Tom Hochstatter Subject: Cook park&92nd Ave. -- SIT2018-00025 Denny,on reviewing your application and plans Engineering has noted that the plans need to show a water quality swale or filter strip on the south side of the west parking lot. Please revise the plans accordingly and re-submit them. Please let me know if you have any questions. Albert Shields 1 Dianna Howse From: Dianna Howse Sent: Wednesday, October 24, 2018 11:19 AM To: Albert Shields Cc: #Building Permit Technicians Subject: RE: SIT2018-00025 - Clean Water Services - Main Sewer Replacement Project Thanks, I have everything now so that I can void this permit./ Dianna L. Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits From: Dianna Howse Sent:Wednesday, October 24, 2018 9:03 AM To:Albert Shields<albert@tigard-or.gov> Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: RE:5112018-00025-Clean Water Services- Main Sewer Replacement Project Hi Albert, I received our plan set of this permit, so I just need the red folder with plans and route slip from you so that I can complete the voiding of this permit. Thank you. Dianna From: Dianna Howse Sent:Tuesday, October 23, 2018 2:07 PM To:#CD PoD<CDPoD@tigard-or.gov>;Tom Hochstatter<TomH@tigard-or.gov>;Albert Shields<albert@tigard-or.gov> Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; Mike White<MikeW@tigard-or.gov>; Mark VanDomelen<markv@tigard-or.gov> Subject:SIT2018-00025-Clean Water Services- Main Sewer Replacement Project I understand from Mike White that this site work permit is to be voided as all work will be performed under the PFI. Please route all building permit application materials, plan sets, red folder,etc.to me so that I can void this permit and have records properly destructed. Thank you. Dianna L. Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1