Permit (172) CITY OF TIGARD SITE WORK PERMIT
° COMMUNITY DEVELOPMENT Permit#: SIT2019-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2019
Parcel: 1S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST
Project: Winco Subdivision: 1995-013 PARTITION PLAT Lot: 2
Project Description: Site work to include removal of existing AC paving at all H.C.parking stalls followed by construction of new code
compliant parking surfaces and will include updated accessibility symbols and signing.
Contractor: DTL BUILDERS INC Owner: WINCO FOOD LLC
13077 S 3600 W ATTN: TAX DEPARTMENT
RIVERTON, UT 84065 PO BOX 5756
BOISE, ID 83705
PHONE: 801-285-5665 PHONE: 208-377-0110
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 04/10/2019 $1,033.92
Plan Review 03/26/2019 $672.05
Type of Use: COM 12%State Surcharge-Building 04/10/2019 $124.07
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 04/10/2019 $6.00
11x17)
Project Valuation: $150,000.00 Erosion Control w/Development 04/10/2019 $236.40
Site Specifics:
Excavation Volume: 120 cu.yd.
Fill Volume: 115 cu.yd.
Impervious Surface: 3900 sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: No
Landscaping: No Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $2,072.44
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 =e:. 32.2344:,
Issued By:
r� , Permittee Signature: J�l
t' 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
RECEIVED IEE FOR OFFICE ISE 0NI.1
III 13125
of Tigard Receiv
Date/Bea /1111121r, P' " // / OC.,7003
13125 SW Hall Blvd.,Tigard,OR 9722F FB 1
A 2019 Plan Review
Other Permit:11111 = Phone: 503.718.2439 Fax: 503.598.196 Date/By: �
Inspection Line: 503.639.4175 Date Ready/By: � `a /�
See Pagee 2 forT I GARD CITY TIGARDInternet: www.tigard-or.gov BUILDINGDIVISION otified/yethod: t Supplemental
Information
A r r
TYPE Or WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 Ne constructionPEK0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTR ON work indicated on this application.
❑ 1-and 2-family dwelling ommercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB BITE INFORMATION AND LOCATION Total number of floors:
Job site address: ",56 ik‘lF.V A e—i - New dwelling area: square feet
potssre
-'�`�
City/State/ZIP: --r-i ,ate ,.^- —te: Garage/carport area: square feet
Suite/bldg./apt.no.: � Project name: LU I ymi-ems /164")"
Covered porch area: square feet
Cross street/directions to job site: 1:::)Al--A��te1 �/1-) S Deck area: square feet
7 , 2 % J{> C C 1JV f""1 _ `' `1 ` Other structure area: square feet
P,
REQUIRED DATA:COMMERCIAL-USE CHECKLIS,
4� Subdivision:•
Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no
ti. equipment,materials,labor,overhead,and the profit for the
' ON OF WORK work indicated on this application.
CifleiC' 'X. 147 \i i%'C-+ }IA_, 11 4,r Valuation: $ 561 eSir.,rInatft1
IIIC p Existing building area: quare feet
't -- x'm pA 1 t New buildingarea: square feet
VIV - u 5, LeLLA,.. 1 > a
-,,.,A - ..,PROPERTY OWNER. Number of stories:
t t Name: L00\111_0 r 5 1.. ' Type of construction:
Address: ( ��% .t .
/ Occupancy groups:
i„7„,City/State/ZIP: �7 / I (i 5 .. 04' Existing:
1�y Phone:(�? ) ?' Ij 1 ax %:( )
.� ' New:
LU'PLICANT ¢,: 0 CONTACT PERSON n ' NOTICE
�> fir`.
Business name: .- ���(7 All contractors and subcontractors are required to be
Contact name: �� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2, i� i A� 71---.
"' jurisdiction in which work is being performed.If the
City/State/ZIP: V � t /,,,,,-,`" ( applicant is exempt from licensing,the following reasons
• ,'A E../ii,, apply:
Phone:(� 3 l 1 e G-I 'ax::( )
E-mail: i� p - �I'2"Y 1 cell-)
CONTRACTOR':
Business name: ` .yX, L3 -- t 1d�.,' BUILDING PERMIT FEES* ,.
(or deposit
Address: �' ra (Please refer to fee schedule)
Lv
Structuralplan review fee
City/State/ZIP: Ai,,e,,{{,,. , C(T ir5/4 lOvy )
Phone: n' ' _' o r / FLS plan review fee(if applicable):
( I),Z ? 5 c. Fax:(g c;) gz. j...64 ,,
CCB lie.: /'f Total fees due upon application:
Amount received:
Authorized signature: `' ` r..,._ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: At +- Date:6,l� ii,4- -'� * Fee methodology set by Tri-County Building Industry
� /-v Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB)
l<,c` c',, �, M
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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.) -41 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) fi % cu.yds.
Retaining structure? (Check one) TA / ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: ,,,,riter sq. ft.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plumbing work. N
Plans Required: See"Site Work Permit Application-Plan Submittal Requirements"attached.
The lowing must accompany this application:
Site Plan with Vicinity Map showing ADA Parking(including ADA)and Lighting
ompliance Plan 60 1114,14, uMC
U/cGrading Plan and details ❑ *Landscaping Plan 1.4//c) utpic ' `'F)
❑ Erosion Control Plan and details 14/f) ❑ Soils Report(if required) a.j%t-,
❑ Retaining Structures N/mss
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation: Permit Pee;
oiew,.Additio is or Rgmred at_ $.00 to$500.00 $51.09 minimum permit fee
Alterations) Submittal $500.01 to$2,000.00 $5-1.09--ter-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-PennitApp.doc 08/02/2016 2
r
Site Work Permit Application
Plan Submittal Requirements
TI G 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. ❑ p&tax lot # [ ,p rt ect name III ite ess ❑ suite number
zoningapplicant name plicant 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.Lr-
2) A route, accessible to persons with disability,leading from the public way to an i„..----
accessible
,/accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible,------
route.
ccessible✓route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.✓
5) Finish grade elevations along the accessible route.,-----
1
B. Topographic survey plan showing grade elevations crossing the entire site. 'AAs'
C. Overall grading plan. ti 0”
D. Utilities plan showing: 14/iTh
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 t /f -
(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.doc 08/02/2016 4
I.
Cop P E T E R S E N • S T A G G S LLETTER OF TRANSMITTAL
ARCHITECTS LLP
NCARB CERTIFIED
5200 W.STATE STREET,BOISE, IDAHO 83703 DATE: JOB NO:
PHONE:(208)345-1462 FAx:(208)345-1532 03/25/19 1803
EMAIL:psa aApsarch.com ATTENTION:
Ms.Julie Drinkwater/Bldg Permit
TO: Technicians
City of Tigard Building Dept.
13125 SW Hall Blvd. RE:
Winco Store#23
Tigard, OR 97223 7501 SW Dartmouth St. Tigard
Accessible Parking Upgrades
ITEMS SENT ARE: _ Attached — For Pick Up_ Sent via
COPIES DATE DESCRIPTION
1 Plan Review fee check in the amount of$672.05
ITEMS SENT ARE:
For your use As requested For review and comment Other
COMMENTS:
COPIES: SIGNED: Lee Lizama–SR.Project Manager-JKM
PLEASE NOTIFY PSA IF ENCLOSURES ARE NOT AS NOTED.
City of Tigard
114 a COMMUNITY DEVELOPMENT DEPARTMENT
■
T I GA RD Building Permit Review — Commercial - No Land Use
Building Permit #: 5„1----;01 0093
Site Address: 7S 0/ _go ..2),_.,4,,,„„L4 Suite/Bldg#: /t
Project Name: (OA c()
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: ti d✓.- ' ....1";'•. ....1";'• i. ��,r! � '"p`,— 'Ae
A A , 1 - 5'i. CCS C' ° r10 / a ��DU
*IP Business Activity: P i-I— ®-nno 24 re"_i
Propos :usiness Activity: /1
IR V.= site address/suite# exists and active in permit syste
°,:ver Terrace Neighborhood: ❑ Yes No
LHing:
rmitted Use: YZEE No ❑ Spec Space
IId C irm no land use required.
Business Licens .
Exists: Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: Date: �2//44
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 t
Original Submittal Date: a, If''(
Site Plans: #
Building Plans: # 3
Building Permit#: . it---Enter building ermit#above.
Workflow Routing: Planning 'ermit Coordinator Building
Workflow Sign-off: s. Sign-off for Planning(include notes from planning review)
Route Application Documents: IT Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
•
By Permit Technician: r,"A. AA,Li/,,Li/�1a Date: ,
I:\Building\Fomis\BldgPemritRvw_COM_NoLandUse 060116.docx
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:E . /
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes EVN/A
Tigard Trans SDC: ❑ Yes CYST
Parks SDC: ❑ Yes L' N/A
OK to Issue Permit
-3/2e3/
Approved by Permit Coordinator: Date: G
I:\Building\Fonns\BIdgPermitRvw_COM NoLandUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7501 SW DARTMOUTH ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Site Work SIT2019-00003
Inspection Type: Inspector:
499 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor