Permit (26) CITY OF TIGARD SITE WORK PERMIT
' ' ' COMMUNITY DEVELOPMENT Permit#: SIT2019-00014
T f A it ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2019
Parcel: 2S 113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Demolition of existing concrete sidewalk,construction of a new rain garden,installation of new storm drain piping,
landscaping,and irrigation piping.
Contractor: OWNER Owner: CLEAN WATER SERVICES
CLEAN WATER SERVICES 2550 SW HILLSBORO HWY
16060 SW 85TH AVENUE HILLSBORO, OR 97123
TIGARD, OR 97224
PHONE: 503-547-8043 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/23/2019 $674.92
Plan Review 05/16/2019 $438.70
Type of Use: COM 12%State Surcharge-Building 05/23/2019 $80.99
Class of Work: ALT Erosion Control w/Development 05/23/2019 $161.40
Project Valuation: Info Process/Archiving-Lg$2.00(over 05/23/2019 $30.00
$75,000.00 11x17)
Site Specifics:
Excavation Volume: 156 cu.yd.
Fill Volume: 70 cu.yd.
Impervious Surface: 440 sq.ft.
Engineered Fill: Yes Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: No
Stom Drains: Retaining Wall:
Fire Underground: No Accessible Parking:
Fence:
Total $1,386.01
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 50, 232.1987 or 1.8.0.332.234,
Issued By: ,. 4/ ice/ 411J Permittee Signature: �� ��
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
7-
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
-isite Work FOR OFFICE USE ONLY
City of Tigard Received
III g E C E I Y E® Plan R
Date/By: ,S!-- L`y1977-- Permit No.: GL C.i ��( t
'. 13125 SW Hall Blvd.,Tigard,OR 97 2 Plan Review/
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ' r . a" ii Other Permit:
TIGARD Inspection Line: 503.639.4175 MAY 13 2019 Date Ready/By: Juris: ® See Page 2 for
Internet www.tigard-or.gov .tified/Method aer/ /1' Supplemental Information
CITY OF TIQ //� ���ijJJ�
3'YPE-6°'#i li w ■ r • 1 i 1 '-1'1'. -AND 2-FAMILY DWELLING'=
❑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
CATEGORY OF CONSTRUCTION: work indicated on this application.
III1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND'LOCATION Total number of floors:
Job site address:16060 SW 855h Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:TPS Bldg Landscape& Covered porch area: square feet
Cross street/directions to job site: Irrigation Project Deck area: square feet
Durham Road and SW 85th Ave Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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
DESCRIPTION OF WORK work indicated on this application.
Demolition of existing concrete sidewalk,construction of a new rain garden, Valuation: $$75,000.00
installation of new storm drain piping,landscaping,and irrigation piping. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Clean Water Services Type of construction:
Address:16060 SW 855h Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(503)547-8043 Fax:( ) New:
® APPLICANT
0 CONTACT PERSON
NOTICE
Business name:Clean Water Services All contractors and subcontractors are required to be
Contact name:Michael Idehara 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)54828849"5117 (/5-2. Fax::( )
E-mail:ideharam@cleanwaterservices.org
; „, . "t: CONTRACTOR ,l.., itz. .. .,
Business name:Clean Water Services(Owner) pi Lti C ,- s 6v-liYig BUILDING PERMIT FEES*
Address: (Please refer to fee schedule) ._
Structural plan review fee(or deposit):
City/State/ZIP:
Phone:( ) Fax:
( ) FLS plan review fee(if applicable):
CCB lie.:N/A Total fees due upon application] ill rg`70
Amount received:i apermit
`l
Authorized signature:.`��%�
%� This permit application expires if a permit is not obtain
A,2 Date: within 180 days after it has been accepted as complet
Print name: /� �lTL ���_-
/,///
* Fee methodoloey set by Tri-County 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: 165 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 235 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90% of maximum density) 70 cu.yds.
Retaining structure? (Check one) ❑ Rock
• CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings, 1261-4.0 v tv 1)&65 SO.F.-
sidewalks, and paving: vsu,n,e., t11.0, c o4* 440 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
Palpation �� ',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\Peanits\SlT-PermitApp.doc 08/02/2016 2
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•
71 Clean Water Services File Number
CleanWateer Services 19-000889
Sensitive Area Pre-Screening Site Assessment RECEIVED
1. Jurisdiction: Tigard
MAY 131019
2. Property Information (example 1S234A801400) 3. Owner Information
Tax lot ID(s): 2S113B000600 Name: CITY OF TIGARD
Company: Clean Water Services BUILDING DIVISION
Address: 2550 SW Hillsboro Hwy
Site Address: 16060 SW 85th Ave City, State, Zip: Hillsboro,Oregon,97123
City, State,Zip: Tigard,Oregon,97224 Phone/Fax: 503-681-3600
Nearest Cross Street: 85th Ave&SW Durham Road E-Mail:
4. Development Activity(check all that apply) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: Michael ldehara
❑ Lot Line Adjustment ❑ Minor Land PartitionCompany: Clean Water Services
❑ Residential Condominium ❑ Commercial Condominium Address: 16060 SW 85th Ave
❑ Residential Subdivision ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Tigard,Oregon,97224
Other Phone/Fax: 5035478152
Site Grading E-Mail: ideharam@cleanwaterservices.org
6. Will the project involve any off-site work? ❑Yes 1.J No ❑ Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
Construction of a new rain garden in an existing planter.Removal of existing hardscape(sidewalks and steps).
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ
1200-C Permit or other permits as issued by the Department of Environmental Quality,Department of State Lands and/or Department of the Army
COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law.
By signing this form,the Owner or Owner's authorized agent or representative,acknowledges and agrees that employees of Clean Water Services have authority
to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify
that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true,complete,and accurate.
Print/Type Name Michael Idehara Print/Type Title
ONLINE SUBMITTAL Date 3/20/2019
FOR DISTRICT USE ONLY
❑ Sensitive areas potentially exist on site or within 200'of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A
SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report
may also be required.
❑ Based on review of the submitted materials and best available information Sensitive areas do not appear to exist on site or within 200'of the site.This
Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently
discovered.This document will serve as your Service Provider letter as required by Resolution and Order 17-05, Section 3.02.1. All required permits and
approvals must be obtained and completed under applicable local,State,and federal law.
IA Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially
sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water
quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order
07-20,Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
❑ This Service Provider Letter is not valid unless CWS approved site plan(s)are attached.
❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2). NO SITE ASSESSMENT OR
SERVICE PROVIDER LETTER IS REQUIRED.
Reviewed by -
Date 3/25/19
2550 SW Hillsboro Highway • Hillsboro,Oregon 97123 • Phone: (503)681-5100 • Fax:(503)681-4439 • www.cleanwaterservices.org
i
GENERAL NOTES
c, ) DURHAki ROAD 1. ARROWS SHOW GENERAL DRAINAGE
DIRECTION.
u,: 2. PROTECT EXISTING IRRIGATION AND
• SITE STRUCTURES DUR G
-... CONSTRUCTION.
3. ACONTRACTOR TO REAS DAMAGED DURI ftE ALL
31)•'''
' " P d e CONSTRUCTION TO P !STING
�I f ��— CONDITIONS.
j it _\ �.Y I 4. NEW SIDEWALKS TO MACH
YY EXISTING GRADES AND LOPES.
_ .). 1II14
J (2)NEW RETAINING 5. CONTRACTOR TO MAIN IN ALL
( I,f WALLS BIO-FILTER BAGS DURI
`� CONSTRUCTION.
C 30 60
LU •
Y(�}t,ti C-02 .` \ jtt
NEW SIDEWALK~ \.
�' i NEW SHOULDER DRAIN �'�^ � � ];� *
I
I I ' TO DAYLIGHT TO DRY yV,'$ NEW SHSI LDFR DRAIN �"`a,,,,}
:NEW SIDEW ISy CREEK BED ,/�S ROCK f' I
E t
q Mi
cTr f SURFACE FLOW AS SHOWN
•• NEW DR h9 \ _ e J �• ) �/t +
j • I CREEK BES J �"{4 � (•—.1();;.: � NEW 4"IRRIGATION SLEEVE,�p SHOWN
.? T1s'+ J r
H, v•d C ]� . �, i.
- { e 'j I NEW SHOULDER DRAIN ROCK AS SHOWN
I NEW RAIN GARDEN /r,,,,.� j—�,
• I$WAILS,WITH NEW CB I fJ �,I {
I.'"AIJp PIPE PLUMBED;11 i {' I „Jj
INTO EXISTING CB •�_ 7 F r I
p • EDET 2C-05 / // YY !/, ]. �/ � I
6,67,6
i / f — — —
'
)I I iC-04 :1'
t ', /'';'''/\z/t/ „ S
'; " f
f
4u a]' n. NEW CONCRETE PAD
— 3 ,^ —- —/— — — AROUND CHARGING
P • '" STATION
I -.I_I_ „ . .
P
4
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/
9 O CIVIL SITE PLAN
a 1
"=30'
@m oax.VC 55 OCT 2015 aaw wuf. SHEET TITLE sties oP: owc w.
DURHAM AVVVVTF CIVIL
S asx DK owcr THIS BAR IS ONE INCH w.
,,,.#.'.5 I, DK cwnLE.6757-DM-C.DWG WHEN DRAWING IS FULL
CleanWaherServices TPS °,2/22/19B C-01
SCALE. o0...�1m..u.a.... LANDSCAPE&IRRIGATION SITE PLAN P«'-
g wPo.SW s�,�E.— REV* DATE aaa �Po PROJECT Pao, Eh�as aMP.
Oregon 9]133.93]9 P 6757.XX
City of Tigard
'1 COMMUNITY DEVELOPMENT DEPARTMENT
.71
T1cnRD Building Permit Review — Commercial - No Land Use
Building Permit #: C)06/11
Site Address: (6060 j\A/ Ave. Suite/Bldg#:
Project Name: (. 1 1447 erti'IVS
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review #
Proposal: )ee,a cc �d "� Utve 5;L.(c lk) r2+-) �i� n :„4,114 ' . o/ Shrill
rM
(,,.r r/;pi11 J.c,akcp`-t,
Existing Business Activity: Okc--qt, J J
Proposed Business Activity: Q111L
VVerify site address/suite# exists and active in permit syste
/.River Terrace Neighborhood: ❑ Yes No
ning: I-p
W�' rmitted Use: C1 Yes ED No CI Spec Space
Lid" Confirm no land use required.
L/ Business License:
Exists: ❑ Yes iNo,applicant notified to obtain business license
Notes: ri r \ bvALA4 1 J„InCe er, cl" 1-6.4A)
CZ) -tea r arealIC (jkuni- arta "("
Approved by Planning: 5141*-e Date: S- (319
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:
Site Plans: #
Building Plans: #
Building Permit#: r building permit#above.
Workflow Routing: grmtt Coordinator t� Butlding
Workflow Sign-off: 0--Sigh-off for Planning(include notes from planning review)
Route Application Documents: g: original permit application, site plans,building plans,engineer and
' beam calculations and trust details,if applicable, etc.
Notes: `11 � C �/✓ a ,/c- Jt -
~By Permit Technician: _ Date: S`r�/
I:\Building\Forms\BldgPermitRvw_COM NoLandUse 060116.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
0 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: KIA
tiS.DC Fees Entered: Wash Co Trans Dev Tax: CIYes �
Tigard Trans SDC: ❑ Yes L_dr'N/
Parks SDC: ❑ YesN/A
K to Issue Permit L(
Approved by Permit Coordinator: II ate: `/9' 11 J
eitstjA
v
c,%%
? tic
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_070915.docx