Permit (209) CITY OF TIGARD SITE WORK PERMIT
. COMMUNITY DEVELOPMENT Permit#: SIT2019-00012
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/07/2019
Parcel: 2S106DB23500
Jurisdiction: Tigard
Site address: 17480 SW CLEMENTINE ST
Project: Clean Water Services Subdivision: RIVER TERRACE NORTHWEST Lot: V
Project Description: Trench installation of a new 16"sanitary sewer force main from SW Clementine Street to the proposed continuation
of force main on SW Roy Rogers Rd.
Contractor: TAPANI INC Owner: CLEAN WATER SERVICES
PO BOX 1900 2550 SW HILLSBORO HWY
BATTLE GROUND,WA 98604 HILLSBORO, OR 97123
PHONE: 360-687-1148 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/07/2019 $1,568.23
Plan Review 04/22/2019 $1,019.35
Type of Use: COM 12%State Surcharge-Building 05/07/2019 $188.19
Class of Work: ALT Erosion Control w/Development 05/07/2019 $311.40
Project Valuation: Info Process/Archiving-Lg$2.00(over 05/07/2019 $66.00
$269,000.00 11x17)
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Stom Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $3,153.17
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 952-001-0090J u may obtain a copy of the rules
or direct questions to e.v C .1987 , 1.800.332.2344.
Issued By: Aie // 4111111V PermitteeSignature:
Call 503.639.4175 by 7:00 a.m.for the next available i ,pection 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
Date/ByReceive: r . 1/j Permit No. ,,
111
- 13125 SW Hall Blvd.,Tigard,OR 97223 E C E I V E D Plan Revi*4"...340—
-r),3—
1- Phone: 503.718.2439 Fax: 503.598.19 Date/By: r�3" %sin Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: ......., . El See Page 2 for
fIGARD Internet: www.tigard-or.gov APR 2 2 2019 Notified/Method . mete r Supplemental Information
TYPE OF
WI
i REQU 1 D DATA:1-AND 2-FAMILY DWELLING
e �L�G � � � Permit fees*are based on the value of the work performed.
❑New construction ❑Demolition
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ®Other:UG Utility equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling 1:1Commercial/industrial Valuation: $
❑Accessory building IIIMulti-familyNumber of bedrooms:
❑Master builder ®Other:Utility-SS Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:N/A /'76/Eft) S (/,„ )A/r- b New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97007 Garage/carport area: square feet
Suite/bldg./apt.no.:N/A Project name:River Terrace North 2 FM/ emi t Covered porch area: square feet
Cross street/directions to job site:River Terrace NW subdivision / Deck area: square feet
17480 SW Clementine St-River Terrace North Pump Station Site Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:River Terrace Northwest Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:Tracts O,P,R,S,T,W / Indicate the value(rounded to the nearest dollar)of all
t 06,4�: 3 110 equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
ipValench installation of new 16"sanitary sewer force main from SW Clementine St
uation: $269,000.00
the proposed continuation of force main on SW Roy Rogers Rd. Existing building area: square feet
See Sensitive Land Review,SLR2018-00006,River Terrace North 2"d FM New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Clean Water Services Type of construction:
Address: 16060 SW 8515 Ave Occupancy groups:
City/State/ZIP:Tigard/OR/97224 Existing:
Phone:(503)913-9490 Fax:( ) New:
{1'a3 ® APPLICANT CI CONTACT PERSON NOTICE
�LIJ Business name:Clean Water Services All contractors and subcontractors are required to be
Contact name:Jeff Hart licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16060 SW 85th Ave jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard/OR/97224 applicant is exempt from licensing,the following reasons
.." apply;
Phone:(503)913-9490 Fax::( )
E-mail:HartJ@CleanWaterServices.org
CONTRACTOR
Business name:Tapani BUILDING PERMIT FEES*
Address:1904 SE 6"'Place (Please refer to fee schedule)
Structural plan review fee(or deposit): . q i
City/State/ZIP:Battle Ground/WA/98604 '/1 1
FLS plan review fee(if applicable):
Phone:(360)216-5159 Fax:( )
Total fees due upon application: $1,568.00
1111B lie.:63434
Amount received:
I'Authorized signature: il li This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Date:4/15/19
Print name:Jeff Hart
r Building-Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(I1/02/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: N/A cu.yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) N/A 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: 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:
❑ 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 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 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
Albert Shields
From: Albert Shields
Sent: Tuesday, April 30, 2019 3:44 PM
To: HartJ@CleanWaterServices.org
Cc: Tom Hochstatter;Agnes Lindor
Subject: SIT2019-00012 held, Conditions of Approval
Attachments: Albert Shields.vcf; Conditions 4-30-2019 CWS SIT2019-00012.pdf
Jeff, I've attached a list of the Conditions of Approval under your land use case, SLR2018-00006,on which I have
highlighted the conditions that remain Not Met but that must be met before we can issue your site permit,SIT2019-
00012. Because I can not release this permit until these conditions have been met I am coding this application as
"Approved (for Plan Review) but Not Released." Plan Review will proceed but the permit will otherwise be on Hold until
all required conditions have been met.
Please let me know if you have any questions.
Albert Shields
City of Tigard
Permit Coordinator
(5331 71a-2426 Work
AIhert tigard-or.gov
13125 SW Hall Blvd.
Tigard, Oregon 97217
www.tigard-or.gov
— – 1
City of Tigard
IIIII III v COMMUNITY DEVELOPMENT DEPARTMENT\
T 1 G A R D Building Permit Review — Commercial - With Land U s e
Building Permit #: ,�''' /'f -Wu 6Z.
Site Address: j 7 900 SW Cie mati hill i---t Suite/Bldg#:
Project Name: RW- Itrace 41) L FM
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review #
Proposal: S t- Vvc,k -c PT (V V� 1-1-14
t
n e iN scl v►t-tc.,✓-N3 Se-w(r C ,-Cs2_ eN-1 c.t\.1
''' Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ' 1 Yes ❑ No
❑ Land Use Case#: su 2 o1 g-OO
0 Plans Match Approved Land Use:
Site Plan 7 Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
Building Height: Maximum Height kr/A- Actual Height
AConditions Met: ❑ Prior to Submittal g Prior to Permit Issuance
fl Btiness License: N/A
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
XPublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: 61)0-t, L`1 U \_,_� Date: // Z Z/ 1 c:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: Y011
Site Plans: # 4
Building Plans: #
Building Permit#: nter wilding permit#above.
Workflow Routing: __ laan�ning B" ngineering C--13 rrr i• Coordinator 'El Buil ng
Workflow Sign-off: LL-Sign- f for Planning(include notes from planning review)
Route Application Documents: wilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,, Date: 4f7J,}/Lsi
I.\Building\Forms\BldgPennitRvw_COM_WithLandUse_060116.docx
Engineering Review
Slope at building pad: WA
Zi PFI Permit#: LO 6 ci __ 65 c ? 5
'Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
...a-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes Ps No
Assess Water Quantity Fee in-lieu: ❑ Yes .e-No
LIDA Facility on lot: ❑ Yes .0' No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: IL—r Date: I c2
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
❑ Co tions "Met"prior to issuance of building permit tOpitrate:
Approved,NOT Released: ��f i` '/o>� l�G�Bs�ro r( 441/9
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Rev' 'on Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes CYN/A
Tigard Trans SDC: ❑ Yes
Parks SDC: ElYes D N/A
OK to Issue Permit
r
Approved by Permit Coordinator: / Date: x/49/1
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse_070915.docx