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Permit
CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Permit#: SIT2019-00011 Date Issued: 05/06/2019 T I(_;A 11 C) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 101 DC03900 Jurisdiction: Tigard Site address: 7150 SW SANDBURG ST Project: Immunology Consultants Laboratory(ICL) Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4 Project Description: ADA parking striping and ADA barrier removal. Contractor: DURUS CONSTRUCTION LLC Owner: LESLIE SANDBURG LLC 15836 UPPER BOONES FERRY RD ATTN:JOHN G LESLIE LAKE OSWEGO, OR 97035 14056 GOODALL RD LAKE OSWEGO, OR 97034 PHONE: 503-320-5633 PHONE: FAX: 503-244-4318 FEES Description Date Amount Specifics: Permit Fee-Site Work 05/06/2019 $231.32 Plan Review 04/12/2019 $150.36 Type of Use: COM 12%State Surcharge-Building 05/06/2019 $27.76 Class of Work: ALT Info Process/Archiving-Lg$2.00(over 05/06/2019 $6.00 11x17) Project Valuation: $15,000.00 Info Process/Archiving-Sm$0.50(up to 05/06/2019 $0.50 11x17) Site Specifics: Excavation Volume: cu.yd. Fill Volume: cu.yd. Impervious Surface: 34768 sq.ft. Engineered Fill: Soil Report Required: No Paving: Grading: No Landscaping: Site Prep: No Stom Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: No Total $415.94 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 ar- set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OU by callin• 503. - .1987 or 1.801.332.2344. Issued By: A Permittee Signature: //UM 4j 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 FOR OFFICE USE ONLY City of Tigard RECEIVE• RDeacteeBived: e Permit No.: 5y ..G .71,_ i.0 1111‘ >/ } - n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 APR D '�1 2019 Date/By: �'��1—)9`� ��'vtia 1`/—�LL 7 Li Inspection Line: 503.639.4175 H 1 R Date ReadyBy: Juris: See Page 2 for T I G A R D Not fied/Method. Supplemental Information Internet: www.tigard-or.gov CITY OF TIGARD •c'�L.� pp DVISION `rrr—E-O%-Wti` .O kIATA I:AND 2-VAMIf YIiW L1NG.,, ❑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. Valuation: $ ❑ 1-and 2-family dwelling %Commercial/industrial ElAccessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND� LOCATION Total number of floors: Job site address: 715-0 SW SAN� t-�e. ST. New dwelling area: square feet City/State/ZIP: T Lt\ .' t 02. 9I . 3Garage/carport area: square feet Suite/bldg./apt.no.: Project name: I C..L_ Covered porch area: square feet Cross street/directions to job site: S W -4-a.,Np 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. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the V rr}�,DESCRIPTION OFFWORK` work indicated on this application. Jl 'bt �n14% IV �.1 0ccc 2oi4. Valuation: $ 1000 n ,' V v,. p it.49 L v--2k ,IV Existing building area: 4'7D&yuare feet S---4.t I S -1 ) l.v -- /"� t ')�/I S-�iivt 4(Ci s , New building area:3..41'-7ce t square feet I$PROPERTY OWNER i${ TENANT ` Number of stories: 2.. {� Name: �o)4A �-5V.2r CC Type of construction: J B Address: \5 e6a. SIrJ -TD.Inc.i NNIe- # I5O Occupancy groups: City/State/ZIP: Tot-k\ ©?— 41-4-.).. -14 . Existing: 2 13u s/K4 S S Phone:(5c3) —4-4--4-— D-.I"kc1-{ Fax:(co )3 -1-4-4-- a•Syy New: 8 Svcs(ntss 0;APPLICANT ❑ CONTACT PERSON NOTICE Business name: CID P \y.c_. All contractors and subcontractors are required to be Contact name: y._>)1V1 Soud nok licensed with the Oregon Construction Contractors Board c! under ORS 701 and may be required to be licensed in the Address: 15,8 ctc 51n) iseVe. 1 st .- a- O jurisdiction in which work is being performed.If the City/State/ZIP: 'A,o al `Q� Gt�a�Lt applicant is exempt from licensing,the following reasons 1 apply: Phone:(S03) ��6, _ I)-.gc Fax: :(5O3) i. o — \6-1- _ E-mail: Y ` S 0 ci;210..ty‘c„ .Com.A. CONTRACTOR Business name: Dwfut.55 Cpv�SlCYvr.-'t10t'. LLC BUILDING PERMIT FEES* Address: lc'836 U([ e �oo e-& F�J •� review(Please fee(orer deposit):fee edutek City/State/ZIP: �oYkojAck t I o� G(-i- [a Structural plan (or Phone:(5)-3 _c7 — 5633 Fax:( ) FLS plan review fee(if applicable): CCB lic.: I es"f35-1 Total fees due upon application: (, 61 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: )4e,11 j cuAl T or o/ Date: 3/a 7/ 'q * Fee methodology set by Tri-County Building Industry ��ff 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: 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 111 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 OF.SUBMITTAL`" #of PlansFe :ti4 (New,Additions or Required at $.00 to$500.00 $51.09 minimum permit fee Gubmitt $500.01 to$2;900:00 - -55-L09-for the first-$-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 City of Tigard 111 COMMUNITY DEVELOPMENT DEPARTMENT I r 1 c a a o Building Permit Review — Commercial - With Land U s e Building Permit #: 5 L jjj9'— ,a j 1 Site Address: flSO jWS'a,i,br,r1 Suite/Bldg#: Project Name: ICL (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review r, Proposal: ADA p�rk,itj .c p+i o rel- (XS( ZOk. Cr Ao 0.kf-ftr re"..,v J. 1./Verify site address/suite# exists and active in permit system.st/ [ er Terrace Neighborhood: ❑ Yes LVS No Lfd Land Use Case#: NAP 01-0000i 0 PlanspIatch Approved Land Use: Site Plan ❑ Landscape Plan ❑ Other: /❑ Urban Forestry Plan ❑ Elevation Plan 'IVicewilding Height: Maximum Height 4c AActtt l Height `J (k4At onditions Met: ❑ Prior to Submittal [ Prior to Permit Issuance Lid' Business License: Exists: ❑ Yes ❑ No,applicant notified to obtain business license /Public Facilities Improvement (PFI) Permit: / Required: CI Yes,applicant was notified [PNo Applied For: El Yes ❑ No,stop intake Notes: Approved by Planning: ,S1.0-1 Lt- Date: Cl-1 H 1 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: El Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: 4/y,I Site Plans: # Building Plans: # � Building Permit#: nter ding permit#above. Workflow Routing: arming EI-Erg veering coordinator ELBtaikeng Workflow Sign-off: gn-off for Planning(include notes from planning review) Route Application Documents: d-iling: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: _Ally:rikAlr - Date: j `r i I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 060116.docx Engineering Review Zr Slope at building pad: 3 P.PFI Permit#: 1✓ e Conditions"Met"prior to issuance of building permit N(A Easements (encroachments) per engineering conditions of approval and plat(not typical on SDR/CUP) frWater 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: f „,, B,./Le_ __ Date: W • Z 3 .1 c( 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: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes c'N/A Tigard Trans SDC: ❑ Yes CR N/A Parks SDC: 0 Yes c®CN/A eR OK to Issue Permit Approved by Permit Coordinator: vo-yvioO� Date: Li 1'. .,a, I l I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 070915.docx