Permit (47) CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2019-00008
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2019
Parcel: 1S136DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY
Project: CENTURIONALPHACENTURION2 Subdivision: None Lot: None
Project Description: Repaving parking lot,overlay of asphalt.
Contractor: ROSE CITY PAVING Owner: CENTURIONALPHACENTURION2 LLC
PO BOX 1598 PO BOX 1171
BORING, OR 97009 LAKE OSWEGO, OR 97035
PHONE: 503-243-1202 PHONE: 503-679-4963
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 03/26/2019 $188.28
Plan Review 03/21/2019 $122.38
Type of Use: COM 12%State Surcharge-Building 03/26/2019 $22.59
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 03/26/2019 $2.00
11x17)
Project Valuation: $10,440.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 4500 sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $335.25
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 :py of the rules
or direct questions to OUNC by calling 503.232.198 .;of. .-344. ry e 0 4 4-
Issued By: Permittee Signature: Asir , v2.,:244/ 4 z
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 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: 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:
TYPE 0#-SUBMITTAL #o Plans. ution• POinit fee.r, '
. �1 , 11t1 IIS or Required at $.00 to$500.00 $51.09 minimum permit fee
Alterations) Submittal - $500..0-1-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
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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes LPN/A
Tigard Trans SDC: ❑ Yes 1 'N/A
Parks SDC: ❑ Yes LAN/A
rOK to Issue Permit
Approved by Permit Coordinator: 4/ "ate: ?/Z V)
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_070915.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11606 SW PACIFIC HWY, TIGARD, OR, 97223 April 22, 2019 at 9:37:06 AM
Record Type: Record ID:
Commercial - Site Work SIT2019-00008
Inspection Type: Inspector:
499 Final inspection Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor