Permit CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit ft: SIT2019-00016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/29/2019
Parcel: 1 S 134BC00500
Jurisdiction: Tigard
Site address: 12388 SW SCHOLLS FERRY RD
Project: McDonald's Subdivision: 1993-057 PARTITION PLAT Lot: 1
Project Description: ADA sidewalk improvements.
Contractor: RICH DUNCAN CONSTRUCTION INC Owner: MCDONALDS CORPORATION (36-0105)
2295 RURAL AVE SE PO BOX 182571
SALEM, OR 97302 COLUMBUS, OH 43218
PHONE: 503-390-4999 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 07/03/2019 $459.82
Plan Review 06/17/2019 $298.88
Type of Use: COM 12%State Surcharge-Building 07/03/2019 $55.18
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 07/03/2019 $6.00
11x17)
Project Valuation: $40,000.00 Info Process/Archiving-Sm$0.50(up to 07/03/2019 $37.50
11x17)
Erosion Control w/Development 07/03/2019 $107.60
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 6737 sq.ft.
Engineered Fill: Soil Report Required: No
Paving: Yes Grading: No
Landscaping: Yes Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $964.98
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 1.800.332.2344.
Issued By: Permittee Signature:
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 OFFICT. I SI:ON Ll
E Received R C
City of Tigard
F�'u'*
III u Date/By: 7 i y l h Permit No.: -'-•- i -ail
13125 SW Hall Blvd.,Tigard,OR 97223 y Plan Review � � �`� Tt L t
Phone: 503.718.2439 Fax: 503.598.1960 (� S °19y 6- 6- /i Other Permit: l P ,ie _ J
Date/By::
T I G A R U Inspection Line: 503.639.4175 �p Date Ready/By: Jur See Page 2 for
Internet: www.tigard-or.gov CITY Of- 11(3A L Noti ethod: / l a, Supplemental Information
r o .. . UILDING DJ„VtSIO' '�,
iiii OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
IXIndicate 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.
0 1-and 2-family dwelling I Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION -, Total number of floors:
Job site address: 1 Z*cs c 4 c .4},o ` ` �I New dwelling area: square feet
City/State/ZIP: 6.4e---T.1 of_. Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name: c PD J S t4.D9 -:_. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DA 'A:COMME IAL-USE CHECKLIST ' .
Subdivision: I 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
t
DESCRIPTION OF WORK ,,, „s# work indicated on this application.
APA- S)Dt71n/A-L-ate- ( IAAa /6,, \_N Valuation: $ �j! °'
frr,I 411: 0i'•A"'V----- l o1J1.) lz>IN) "rb 4-[)- N1 Existing building area: 4,47D1j square feet
New building area: % square feet
- ... , 0.6,,,R9iEjtry,O o, kVAa'TENANT Number of stories: I
Name: � Lei C ,� (�D e---M1
.
S v"r"'[ Fel `D N.1 Type of construction: Va
Address: ��qo' dlft-i - e..vo S.re, 'lbc Occupancy p y groups:
City/State/ZIP: W e- )1,cA
(, C__A- cii-f :3-1 Existing: 4 Z
Phone:47-5 G�-p-�
• oz-tic Fax ( )
New: AV a Gib'E
APPLICANT F: '' A. a CONTACT PERSON ' "' 7 .,7' ‘_
Business name: ebe-IrCS All contractors and subcontractors are required to be
Contact name: raj CL JD licensed with the Oregon Construction Contractors Board
D • under ORS 701 and may be required to be licensed in the
Address: 014.5�� Z2) jurisdiction in which work is being performed.If the
City/State/ZIP: !D- Dig- ZO l applicant is exempt from licensing,the following reasons
Phone:( - Fax::( )
E-mail: IiIAAq, 4Qfi/1/)(l u A ttS• k .--
CO TRAC�'OR
Business name: g .' r _
BUILDING PERMIT FEES*
Address: a2 c---- 4,✓•Gl/ 5%
(Please e�terro eescbuf+7e)
City/State/ZIP: ! Structural plan review fee(or deposit):
Phone:(9)3) 3 !d , t�d�, Fax:( ) FLS plan review fee(if applicable):
CCB lic.: l 5---b-330 / /_ Total fees due upon application: A`j
/ ! !!! Amount received:
Authorized signature: G_
This permit application expires if a permit is not obtained
Print name: Date: �Q within 180 days after it has been accepted as complete.
flef" f * Fee methodology set by Tri-County Building Industry
Service Board.
I:\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: +PS cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) le 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
EConcrete
Other:
*Total new impervious area including all buildings,
sidewalks, and paving: ZS 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:
124 Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting
compliance Plan
6, Grading Plan and details ❑ *Landscaping Plan
►.I Erosion Control Plan and details ❑ Soils Report(if required)
Retaining Structures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: uter Permit Fee K Y
f.;. ,
(blew.Additions or Required at $.00 to$500.00 $51.09 minimum permit fee
Aiteraflonsy u nit $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
$10.76 for each additional$1,000 or
Multi-Family R-1 Occupancy 3 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
• Site Work Permit Application
Plan Submittal Requirements
T I c;A R DCommercial,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
El zoning
B. North arrow. ❑ applicant name ❑ applicant phone number
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.
-13-. Topographie-turvey-planshowing-grAde-elevations-raossing 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.
1:\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-PernutApp.doc 08/02/2016 4
A
Clean Water Services File Number
CleanWate� Services 119-001985
Sensitive Area Pre-Screening Site Assessment
1. Jurisdiction: TIGARD
2. Property Information(example 1S234AB01400)
3. Owner Information
Tax lot ID(s): 1S 1 34Rcnnsno Name: ROBERTYAGUSESKY
Company: MCDONALD'S CORPORATION
Address: 2999 OAK ROAD STE 900
QB Site Address: City,State,Zip: WALNUT CREEK,CA,94597
City,State,Zip: Phone/Fax: 205.3484374
Nearest Cross Street: E-Mail: ROBERT.YAGUSESKY@US.MCD.00M
4. Development Activity(check all that apply)pp Y) 5. Applicant Information
❑ Addition to Single Family Residence(rooms,deck,garage) Name: MATT GRINNELL
❑ Lot Line Adjustment ❑ Minor Land Partition
Company: FREIHEIT ARCHITECTURE
Li Residential Condominium ❑ Commercial Condominium
❑ Residential Subdivision Address: 929108TH AVE NE STE 210
❑ Commercial Subdivision
laSingle Lot Commercial laMulti Lot Commercial City,State,Zip: BELLEVUE,WA,9e004
Other Phone/Fax: 425-827-2190
E-Mail: MGRINNELL@FREIHEITARCH.COM
6. Will the project involve any off-site work? ❑Yes ❑No ❑Unknown
Location and description of off-site work CONNECTING SIDEWALK TO ROW
7. Additional comments or information that may be needed to understand your project WE ARE DO ADA IMPROVEMENTS TO THE SIDEWALK
TO ENSURE THAT THE SITE IS ACCESSIBLE TO ALL.WE ARE ADDING A PEDESTRICAN CONNECTION TO THE ROW TO ENSURE SAFE PASSAGE ON SITE.
This application does NOT replace Grading and Erosion Control Permits,Connection Permits,
Building Permits,Se Development Permit ,
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 MATT GRINNELL
Print/Type Title PROJECT COORDINATOR
Signature / ,/ ,v;"
// Date 6/19/2019
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 19-05, Section 3.02.1. All required permits and approvals must be
obtained and completed under applicable local,State,and federal law.
15(Bait ormIgWalhe submltlefimateriats 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 19-05,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 ,".:`' �-'
N Date 6/25/19
Once complete, email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 6/2017
111 City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
1111
T I G A R D Building Permit Review — Commercial - With Land U s e
Building Permit #: S77:9,0/9-ak)i c;
Site Address: 123630 SW __,ho((Sri, Suite/Bldg#:
Project Name: M G Dong►6(c Si e-v o
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Sp}L woN-_ /VD4 1 M,,,,,P tc
Verify site address/suite#exists and active in permit system.
tg-River Terrace Neighborhood: ❑ Yes XT No
K,Land Use Case#: i,/`MO2o i x,000 t 3
-13"-Plans Match Approved Land Use:
Site Plan Landscape Plan 0 Other:
NA-Urban Forestry Plan Elevation Plan
KevBuilding Height: Maximum Height Actual Height
1K Conditions Met:NW.. ❑ Prior to Submittal ❑ Prior to Permit Issuance
I,Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning:
„e„,�
Date: 0 111 1 Pi
Revisions (after Building Submitta only) Reviewer
Revision 1: ❑ Approved ❑ Not Approved Date
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date:
Site Frans: 3
Building Plans: # 3
Building Permit#: �i.-£irrer building permit#above.
Workflow Routing: arming �.
"ngineering D. ermit Coordinator ung
Workflow Sign-off: {2-8 gn-off for Planning(include notes from planning review)
Route Application Documents: : original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: - a
t-'
�-y� Date: Y'
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 060116.docx