Permit CITY OF TIGARD SITE WORK PERMIT
11111 -11 COMMUNITY DEVELOPMENT Permit#: SIT2019-00017
T I t A I{f7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2019
Parcel: 1S134BD07200
Jurisdiction: Tigard
Site address: 10900 SW 121ST AVE
Project: Trinity Community Church Subdivision: SUMMERBROOK SUBDIVISION Lot:
Project Description: New site steps from sidewalk grade to entry,replacement and relocation of existing non-compliant pedestrian
ramp,and replacement of existing sidewalk at building entry.
Contractor: YORKE&CURTIS Owner: TRINITY CHURCH OF THE EVANGELICAL
4480 SW 101ST AVE 10900 SW 121ST AVENUE
BEAVERTON,OR 97005 TIGARD, OR 97223
PHONE: 646-2123 PHONE:
FAX: FAX 643-5531
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 07/31/2019 $1,146.17
Plan Review 07/16/2019 $745.01
Type of Use: COM 12%State Surcharge-Building 07/31/2019 $137.54
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 07/31/2019 $20.00
11x17)
Project Valuation: $175,000.00
Site Specifics:
Excavation Volume: 0 cu.yd.
Fill Volume: 80 cu.yd.
Impervious Surface: 25516 sq.ft.
Engineered Fill: No Soil Report Required:
Paving: No Grading: No
Landscaping: No Site Prep:
Stom Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $2,048.72
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 .re set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay btain a copy of the rules
or direct questions to O C by c ' g,50 /32.19:7. 1.800.332.2344.
Issued By: /f 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 RECEIVED
FOR OFFICE USE ONLY
1,1 - City of Tigard J U L 1 6 2019 Receiv _ AE
13125 SW Hall Blvd.,Tigard,OR 97223
Date/'eview /iii. �./1_, -e/o
DPlan Review cy /
Phone: 503.718.2439 Fax: so3s9s.19�ITY OF TIGARD 7 _l ,/ r 5f
TIGARD 070,1
Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: ��� /� �� See �2for
Internet: www.ti and-or. ov y o •7 /7 -oris: I S Page 2 for
g g Notif ettNI thod:( Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Addition/alteration replacement Indicate the value(rounded to the nearest dollar)of all
❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building
❑Multi-family Number of bedrooms:
❑Master builder ElOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:10900 SW 121st Ave New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Trinity Community Church
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
South of SW Scholls Ferry Rd,Past SW Springwood Dr,East side of street.
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.:7200 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:1S134BD 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.
New site steps from sidewalk grade to entry,replacement and relocation of Valuation: $175,000.00
existing non-compliant pedestrian ramp,and replacement of existing sidewalk Existing building area: 13409 square feet
at building entry. New building area: 13409 square feet
10 PROPERTY OWNER 1 0 TENANT Number of stories: 2
Name:Trinity Community Church
Type of construction: VB
Address:10900 SW 121st Ave
Occupancy groups:
City/State/ZIP:Tigard,Oregon 97223
Existing: A-3
Phone:(503)686-3364 Fax:( )
New: A-3
e APPLICANT'' 0 CONTACT PERSON
Business name:CIDA
NOTICE
All contractors and subcontractors are required to be
Contact name:Leslie Jones licensed with the Oregon Construction Contractors Board
Address: 15895 SW 72"d Ave under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP:Portland OR 97224 applicant is exempt from licensing,the following reasons
Phnnr•(� ,_apply
- i ( ) -
t+ax: - �..
E-mail:LeslieJCdcidainc.com
CONTRACTOR
Business name:Yorke&Curtis
BUILDING PERMIT FEES*
Address:4480 SW 101st Ave (Please refer to fee schedule
Structural plan review fee(or deposit):
City/State/ZIP:Beaverton,Oregon 97005
FLS plan review fee(if applicable):
Phone:(503)646-2123 I Fax:( )
CCB lic.:55644 Total fees due upon application:
Authorized signature: �� Amount received:
This permit application expires if a permit is not obtained
I Print name: �e�l i C ...\,,,,,s I Date: 1/15/ 1 Gt I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
C\Building\Permits\SIT-PermitA doc 08/02/2016 Service Board.
PP• 440-4613T(11/02/COM/WEB)
PageCity of2 Tigard: SiteInformation Work Permit Checklist
- Supplemental
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: 0 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) 'En cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: Zcl, S167 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)
[11 Retaining Structures
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans Valuation: , Permit Fee:
(Newt Additions or Required at $.00 to$500.00 $51.09 minimum permit fee
Alterations) Submitt $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.
1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
111
Site Work Permit Application
TIGARD Plan Submittal Requirements
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
_ _ _. 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
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.doc 08/02/2016 4
W YAT
FIRE PROTECTION, INC.
9095 S.W. Burnham
Tigard,OR 97223
Fire Hydrant Fire Flow
PROJECT TRINITY CHURCH
ADDRESS 10900 SW 121st AVE
I CROSS STREET
FLOW
HYDRANT SOUTH END OF PARKING LOT
LOCATION
STATIC 70
PITOT RESIDUAL 22.5
GPM 11782.5 4" HOSE MONSTER PORT FLOWED
GPM AT 20 PSI 5599 calculated per IVFPA 291
DATED 08.16.18 7:30 AM
MONITOR
HYDRANT NORTH END OF PARKING LOT
LOCATION
STATIC 70
RESIDUAL 64
DATED 08.16.18 7:30 AM
WITNESS
WITNESSED BY KAY LANDSIEDEL
TITLE
ORGANIZATION CITY OF TIGARD PUBLIC WORKS
SIGNATURE
PERFORMED BY ; JACK GARDNER
City of Tigard
'1 COMMUNITY DEVELOPMENT DEPARTMENT
INTIGA
RD Building Permit Review — Commercial - No Land Use---
Building Permit #: 0/ _ C�6�7
Site Address: ` F �
IoiiJO SV iZ1 i�a A . Suite/Bldg#:
Project Name: Tr 7 (1 t,,.,,p.) �
(Name of commercial business occupying thespace. If
PY g vacant,enter Spec Space.)
Planning Reviewr
Proposal: St �,,trk Lt) . S""I t'.1 c, j k 3 rG L of-
Alm
{�,,f} fA.,e, A��.�,^^r} dP
4 Ij .c.L,AL J- ‘.,i di,- al r.
Existing Business Activity: CL,,2i‘ - ftI114
Proposed Business Activity: Cki,
Of Verify site address/suite#exists and active in permit syste .
Er/River Terrace? . borhood: 0 Yes lir No
toning: 1C-1*.
Ci P rmitted Use: Ltd'Yes 0 No 0 Spec Space r�
L'�'Confirm no land use required. S I
pi-Business License:
Exists: 0 Yes 0 No,applicant notified to obtain business license
Notes: ka 4 ue, 6.( ,-4 , F I '
Ot G ( �[rGtk 15`�d1�1� �^CC(4tC A ' an�. r rp/{,� W�4 fl li i& QI�G�
Approved by Planning: 4. [, L. 7'16-141 Date:
Revisions (after Building Submittal only) Reviewer
Revision 1: Date
0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: 7 7(2 7/c??Site Plans:
Building Plans: #
Building Permit#: n, nter building permit#above.
Workflow Routing: .51 lanning
Si off: � g �Pernut Coordinator L ui�g
- Sign-off for Planning(include notes from planning review)
Route Application Documents: Si Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:
Date: 7/777//7
1:\Building\FormslBldgPermitRvw_COM_NoLandUse 060116.docx
Engineering Review
2"-Slope at building pad: 2®je
❑ PFI Permit#:
Conditions "Met"prior to issuance of building permit
Er Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
I� Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes C'r No
Assess Water Quantity Fee in-lieu: ❑ Yes C;)-'No
LIDA Facility on lot: D Yes 21'No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date: '7//fj J/7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: D 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: ��
VDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes L�`f/N/A
Tigard Trans SDC: 0 Yes L.(d�N/A
Parks SDE: ❑ Yes /A
OK to Issue Permit
Approved by Permit Coordinator: ate:
I:\Building\Forms\BldgPermitRvw_COM_WithlandUse 070915.docx