Permit (34) CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2019-00006
T i(j+1 R f] 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/17/2019
Parcel: 25111 ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Subdivision: None Lot: None
Project Description: Site work for relocating(5)portable buildings and a temporary parking lot.
Contractor: TRIPLETT WELLMAN INC Owner: UNION HIGH SCHOOL DISTRICT
PO BOX 160 NO. 3 JT
WOODBURN, OR 97071 00000
PHONE: 503-982-4188 PHONE:
FAX: 503-982-0390
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 04/18/2019 $1,258.42
Plan Review 03/20/2019 $817.97
Type of Use: COM 12%State Surcharge-Building 04/18/2019 $151.01
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 04/18/2019 $30.00
11x17)
Project Valuation: $200,000.00 Info Process/Archiving-Sm$0.50(up to 04/18/2019 $100.00
11x17)
Erosion Control w/Development 04/18/2019 $236.40
Site Specifics:
Excavation Volume: 450 cu.yd.
Fill Volume: 0 cu.yd.
Impervious Surface: 4750 sq.ft.
Engineered Fill: No Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Stom Drains: Retaining Wall: Yes
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $2,593.80
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
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. .0 may obtain a copy of the rules
or direct questions to OU by calling 503.232.198723or 1.800.332.2344.
Issued By: 4, • Li^�`_(4, .,457—Permittee Signature:
>11GG
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.
Buit'din2 Permit Application
Site Work FOR OFF Ic I ISE ONEN
ClOf Tigard M �D Received L° permit No.: ti..... f
`J g Date/By. .,ltel /1 1 1�v--- L t�
u 13125 SW Hall Blvd.,Tigard,OR 97 C Plan Review
Other Permit: 1 c I
' '. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: � ' 3'� ) 9 �G�: (�d�"�"�-�`�l
T't L A R D Inspection Line: 503.639.4175 2019 Date Ready/By. Jam- See Page 2 for
w
Internet: ww.tigard-or.gov Notified/Method:6.,1/(' ,y i, 0f }t 6 I ® See
Information
,�
. ,,e TIGARD tN01,1,,//d hw !✓,J.�"
TYPE OF`WOKING UIVtS1 ktEQTJ 3 DAtA:1-A 2-I A IL'Y D LLING
0 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
0 Addition/alteration/replacement ®Other:Manufactured equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTIONwork indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation:Commercial/industrial
D Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ®Other:Manufactured Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:14650 SW 97th Street New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Twality Mid Sch-Portables Covered porch area: square feet
Cross street/directions to job site:97t''and Murdock Street Deck area: square feet
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.:2S111ACO2700 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.
'-"Y All site work to install(5)portable buildings and a temporary parking lot Valuation: $ , ,9C0 v
Existing building area: square feet
New building area: square feet
/13 PROPERTY OWNER 0 TENANT Number of stories:
Name:Tigard-Tualatin School District Type of construction:
Address:6960 SW Sandburg Street Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)431-4000 Fax:( ) New:
l APPLICANT 0 CONTACT PERSON NOTICE
Business name:Day CPM All contractors and subcontractors are required to be
Contact name:Shawn Christensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:6960 SW Sandburg Street jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(971)727-4168 Fax::( )
E-mail:
CONTRACTOR
Business name:Triplett Wellman BUILDING PERMIT FEES*
Address:1717 Mt Jefferson Ave (Please rgjetrnjeeschedule)
Structural plan review fee(or deposit):
City/State/ZIP:Woodburn,OR 97071
Phone:(503)982-4188 Fax:( ) FLS plan review fee(if applicable):
CCB lic.:43496 Total fees due upon application: 1 t 7 17
Amount received:
Authorized signature: f---7.:C....0'
. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Shawn Christensen Date:03/08/2019 * Fee methodology set by Tri-County Building Industry
Service Board.
\Building\Permits\STT-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: 450 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 450 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 0 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 4,750 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
Commercial 3 $2.69 for each additional$100 or fraction
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
II 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. ❑ map &tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant 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.
2) A route, accessible to persons with disability,leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
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
(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
r
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.doe 08/02/2016 4
1
City of Tigard
1114 'I COMMUNITY DEVELOPMENT DEPARTMENT
111
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: 1/--a) 4,
Site Address: [ijc SVA/ Cfl' ll AY-(01` Suite/Bldg#:
Project Name: V\itAA k il M kttillei :S hCb I
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review },
Proposal: MGk9�V ) t p U' Iafi .-to '1G4
, - Gttt* � t`'/1'Vl pi i't) p k tvi It .
.Verify site address/suite# exists and active in permit system.
..River Terrace Neighborhood: ❑ Yes No
-N Land Use Case#: \)Q.2-0 f l—0O(UQ2 C' c"2-0
.(Plans Match Approved Land Use:
igtSite Plan rst4 Landscape Plan ❑ Other:
rban Forestry Plan Nik Elevation Plan
Building Height: Maximum Height ctual Height
. Conditions Met: `0.- Prior to Submittal ❑�Prior to Permit Issuance
It Business License:
Exists: El Yes ❑ No,applicant notified to obtain business license
„ Public Facilities Improvement(PFI) Permit:
Required: Ye�s,,applicant was notiified ❑ No Applied For: Yes ElNo,stop intake
Notes: U �/Y Y I C��'1 t,1 lUl. 111() ,
Approved by Planning: .I/v L 4 /A., Date:
) Ki 11e)
Revisions (after Building Submittal on $ Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: /j/
7 I/
Site Plans: �/
Building Plans: #
Building Permit#: [�—Ent—er building permit#above.
Workflow Routing: LT 1'tanningrigineeringt Coordinator lThEVEring
Workflow Sign-off: --off for Planning(include notes from planning review)
Route Application Documents: ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: Date: 3/07
I:\Building\Forms\BldgPenmtRvw_COM_WithLandUse 060 1 16.docx
Engineering Review
Slope at building pad: VA-t24 G --2_--
0
--Z❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes .Q No
Assess Water Quantity Fee in-lieu: ❑ Yes .1 No
LIDA Facility on lot: ❑ Yes 4- No
,'NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date: 4i( C c J
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:
12r-SDC Fees Entered: Wash Co Trans Dev Tax: 0 Yes ,,�N/A
L
Tigard Trans SDC: 0 Yes Y2(N/A
Parks SDC: 0 Yes N/A
CEJ OK to Issue Permit
Approvedby Permit Coordinator: Date: 4/1 0/
�y
I:\Building\Forms\B1dgPermitRvw COM_WithLandUse_070915.docx