Permit (54) CITY OF TIGARD COMMERCIAL MANUFACTURED
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STRUCTURE PERMIT
-; COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Permit#: CMS2019 00004
Date Issued: 08/01/2019
Parcel: 1S134BD11800
Site address: 12079 SW SUMMERBROOK LN Jurisdiction: Tigard
Project: Summerbrook, Lot 1 Subdivision: SUMMERBROOK SUBDIVISION Lot: 1
Project Description: Sales trailer set up. No accessibility ramps to be constructed as sales trailer is on grade per applicant and will use
a temporary sanitary sewer tank so no sewer connection permit is required.
Contractor: WILLIAM SCOTSMAN INC Owner: WILLOW CREEK LAND LLC
13132 N WOODBRUSH WAY PO BOX 1060
PORTLAND, OR 97203 WOODBURN, OR 97071
PHONE: 503-285-6165 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM MH State Admin 07/31/2019 $30.00
Class of Work: OTR Type of Const: VB MH BLD Permit 07/31/2019 $275.50
Occupancy Group: B 12%State Surcharge-Building 07/31/2019 $33.06
Stories: 0 Height: 0 ft Erosion Control w/Development 07/31/2019 $80.70
Project Valuation: $0.00 Info Process/Archiving-Sm$0.50(up to 07/31/2019 $2.50
11x17)
Floor Areas:
First Floor Area: 510
Second Floor Area: 0
Third Floor Area: 0
Total Area: 0
Required Setbacks:
Left: 0 Right: 0
Front: 0 Rear: 0
Required:
Parking Spaces: 0 Fire Sprinklers: No Total $421.76
Smoke Detectors: Yes Party Wall: No 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. 32.1987 or 1.800.332.2344.
Issued By: .. --'-- tte�Signature:
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_____ itic.-5--4,4c2r.
Call 5 3 5 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.
Manufactured Structure
rilPlacement Permit Application , ` -` I OROl11( 1. 1St_0 I 1
City of Tigard J U L 2 b 2019 Received.
Date/By- 7 25 Permit No.
,111 q 13125 SW Hall Blvd.,Tigard,OR 97223 e y G.�Ses24�l9 '�@O�r
Phone: 503 718.2439 Fax: 503 598. !�1,�", .050.1.144010 Pian Review ) 4 Other Permit:
T I G A R D Inspection Line: 503.639.4175 ..1, `' -+It m F ,p �y/By: ^� tunas plan SubaI
Internet: www.tigard-or.gov belt LIi IYAVIM I ' .otified/M-•.:.: 9 , 1 Reyui„emenn
JOB SITE INFOR\I%'FIO , / // OV NEI( I\FOR\1:A1ION
Site Address: i Zc 79
SV SU/1 ll.,t& /.44€O K Name: W//(CJu C e (Am 0 L(-6--
Park Name: Address: y�
Subdivision&Lot#: SiJMM6ti Lt71- #/ Po ( jC 10600
Directions to inspection site: City: State ZIP
_� /► � ����,�� -c�2 � X70-1(
0(11 df Sid i Z,51– f71/l Phone: Fax:
Is property inside city limits? I_; Yes ❑ No E-mail:
LO( -AL G01'FRN\IF\"I :1PPRO\'.LS
Zoning Sanitation
Signature: Signature:
Jurisdiction: Jurisdiction:
Date: Date:
11 1\t F_1( fl RLD PI..1(F\11 \I PERMIT Il l'S
Cost(each) No.of Sum
(l) Installation/re-inspection Items
(a) Placement(includes placement,electrical feeder,30'of water/sewer connection)- $ 275.50 $
(b) State surcharge at 12%(of placement fee only): $ 33.06 $
(b) Re-inspection(includes inspection and 12%state surcharge)- $ 100,80 $
Placement permit to be obtained only by homeowner,or Oregon-licensed manufactured dwelling installer.
(2) Electrical
(a) Service and/or feeder(new service installation or alteration/relocation of existing service). $ See Electrical Permit Application
Electrical service permit to be obtained only by homeowner performing work or signing supervisor of Oregon-licensed electrical contractor
performing work.
(3) Plumbing
(a) New water service(for services over 30 lineal feet)- $ See Plumbing Permit Application
(b) New sanitation/storm sewer or rain drain(for services over 30 lineal feet)- $ See Plumbing Permit Application
Plumbing permit to be obtained only by homeowner performing work or Oregon-licensed plumbing contractor performing work.
(4) Miscellaneous fees
(a) Administrative fee(State of Oregon). $ 30.00 $
(b) System development fees(sewer connection,storm water,parks development&traffic impact). $ See Permit&System Development Fees
SUB-TOTAL $
SI..I l P OR INS I A1.1.1 I ION ( ON"I R,1( IOR \ . 1. 1PPL1(;_ N I
Name: . •► iP le)IL-L-1 I�tr1 S C c'C?5 J"1A'nl ` C-1;ame: b40l V.1 64:/-e'? I%,-14.)41C-5
Address: is i 3� 1 Y 1006 �st, w1 y Address:'q05
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L City: 1 /y K/ State: ZIP- City: .7 !V ` St ��L' ZIP:
Phone �45,e�_c..6,j�� Fax: Phone: sagFax:
CCB No.: i5 7•,.7MIDI No.: E-Mail: ;\, _ -
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SKIRTING CONTRACTOR
Name: I ereb,certify=that the infgrmalion above is true and correct
A work i ft performed all be in accordance with all
Address: g verning ' , ml.
City: State: ZIP: hi —1 4 t Ai
Phone: Fax: 'V
Si: attire D e
CCB No.: I MDI/LSI No.: Print . e: m 1 f `r ' j ,e.`,,
iso,Building\Permits\CMS-PermitApp.doc 02/27/2018
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City of Tigard
IIII COMMUNITY DEVELOPMENT DEPARTMENT
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T1cARo Building Permit Review — Commercial - With Land Use
Building Permit #: CMS ..9-0/9 -- 6000Y
Site Address: 069-5 l,L' ,c18mmk_ �- - Suite/Bldg#:
Project Name: Ri(inikir-ArV- d ���z, (PP-'
,c_
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 1Il l) ` so l "& iczi Le
/T ,-
-rify site address/suite# exists and active inste .ermit s
p Y
II`$''ver Terrace Neighborhood: ❑ Yes No
[% and Use Case#: 77fifo2 019.__Dn o/
.2
iv Plan atch Approved Land Use: \ 0(
w Si • Plan dscape Plan er:
\i_11: ►rban Forestry Plan ivation Plan
0 Building Height: Maximum Height (�' Actual Height G SO
` onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Ousiness License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
,04 ublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake
Notes:
441.111
Approved by Planning: Li. Date: DM
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: # 7/ J/ 9
Site Plans:
Building Plans: # .2
Building Permit#: 0 Enter building permit#above.
Workflow Routing: 4 Planning :: Engineering FP Permit Coordinator /Ind' Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: *pVi original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 7126 - Date: 7/7-C,//�
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Engineering Review �y
Slope at building pad:
[VPFI Permit#: Z 449/ .---- O23 ,/
❑ Conditions "Met"prior to issuance of building permit i7/I
❑ 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 l'No
Assess Water Quantity Fee in-lieu: ❑ Yes [ 'No
LIDA Facility on lot: ❑ Yes S No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date:
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:
'SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
1 OK to Issue Permit Q
Approved by Permit Coordinator: 3Q1 ^e1 Date: 7 l ) ( -1
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