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Permit CITY OF TIGARD SITE WORK PERMIT 111 .___ at COMMUNITY DEVELOPMENT Permit#: SIT2019-00023 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2020 TfGARD g Parcel: 2S101BB00301 Jurisdiction: Tigard Site address: 11834 SW PACIFIC HWY Project: Jacksons Food Store Subdivision: TIGARD ROAD GARDENS Lot: 1 Project Description: Modification to the parking lot,retaining wall,tree removal,and new plantings. The existing convenience store, fueling canopy,fuel dispensers and underground storage tanks will remain. Contractor: RICH DUNCAN CONSTRUCTION INC Owner: PACWEST ENERGY LLC 2295 RURAL AVE SE 3450 COMMERCIAL CT SALEM, OR 97302 MERIDIAN, ID 83642 PHONE: 503-390-4999 PHONE: 208-888-6061 FAX FEES Description Date Amount Specifics: Permit Fee-Site Work 02/05/2020 $387.28 Plan Review 10/17/2019 $251.73 Type of Use: COM 12%State Surcharge-Building 02/05/2020 $46.47 Class of Work: OTR Info Process/Archiving-Lg$2.00(over 02/05/2020 $14.00 11x17) Project Valuation: $30,672.50 Info Process/Archiving-Sm$0.50(up to 02/05/2020 $99.00 11x17) Erosion Control w/Development 02/05/2020 $107.60 Site Specifics: Excavation Volume: 10 cu.yd. Fill Volume: 120 cu.yd. Impervious Surface: 950 sq.ft. Engineered Fill: Yes Soil Report Required: Paving: Yes Grading: No Landscaping: Yes Site Prep: No Storn Drains: Retaining Wall: Yes Fire Underground: No Accessible Parking: No Fence: Yes Total $906.08 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 ad Med by the Oregon Utility Notification Center. hose r s are et forth i AR,,952-001-0010through OAR 952-001-00s0: Y u may ob nja copy of the rules or direct questions to OUN calk 503.23 87 0.3 . 344. Issued By: e Permittee Signature: %%(6 (� .- 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 riECEIVED FOR OFFICE USE ONLY City of Tigard Eew IN . 13125 SWHallBlvdTigard,OR 97223 0CT 16 2019 1 Phone: 503.718.2439 Fax: 503.598.1960 ,.aa �y Date/B : r. 4 '1 Other Permit: I I i,,1 R 1) Inspection Line: 503.639.4175 CITY OF 16G,%nL 4 Date Ready :y: kills: H See Page 2 for Internet: www.tigard-or.gov -) f 3 S 1 Sk l r° Y ;',?.1I. ,I f!\ Notified/Method: i- ifl Supplemental Information IF: 1"""( (.1-✓-A/1? TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING Permit fees*are based on the value of the work performed. ❑New construction ❑Demolition Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 'Other:Modification equipment,materials,labor,overhead,and the profit for the work indicated on this application. CATEGORY OF CONSTRUCTION PP ❑ 1-and 2-family dwelling [j�Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ElMaster builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11834 SW Pacific Highway New dwelling area: square feet City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:Redevelopment of Jacksons Food Store Covered porch area: square feet Cross street/directions to job site: Pacific Highway W and SW Garden Place Deck area: square feet Other structure area: square feet REQUIRPD DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: R2194220 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. Project includes a modification to the parking lot,retaining wall, tree removal and Valuation: $ 30,672.50 new plantings.The existing convenience store,fueling canopy,fuel dispensers, Existing building area: 1 876 square feet and underground storage tanks will remain. New building area: 1,876 square feet wroPROPERTY OWNER 0 TENANT Number of stories: 1 Name: PacWest Energy,LLC dba Jacksons Food Stores,Inc. Type of construction: N/A-Wall Address: 3450 E Commercial Court Occupancy groups: City/State/ZIP: Meridian,ID 83642 Existing: M Phone:( 208)888-6061 x206 Fax:( ) New: M 0 APPLICANT ritCONTACT PERSON '' ��.; rx- NOTICE Business name: Barghausen Consulting Engineers,Inc. All contractors and subcontractors are required to be Contact name: Charles Moseley licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 18215 72nd Avenue South jurisdiction in which work is being performed.If the City/State/ZIP: Kent,WA 98032 applicant is exempt from licensing,the following reasons apply: Phone:( 425 ) 656-7406 Fax::( ) E-mail: cmoseley@barghausen.com ' t Business name: TBD �'lir 4 9UVLCJt . �iMoit_ICukt BUILDING PERMIT FEES* Address: 2 Z-" \Zoswt IIkk)� �� (Pleas refer to fee schedule) �A ` oL Structural plan review fee(or deposit): City/State/ZIP: `J r, Phone: i> ) '1C{,(?(,��t g eme( FLS plan review fee(if applicable): Fax:( ) CCB lie.: /us-q J 1/lc!-Z Total fees due upon application: ` ,,, (� Amount received: Authorized signature: T67-4-6 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Charles Moseley Dat 10/2/2019 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 4 0-4613T(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: 10 cu. yds. Grading Volume: (Soils report required for>5,000 cu.yds.) 0 cu. yds. Fill Volume: (Fill exceeding 12”in depth shall be compacted to 90%of maximum density) 120 cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete Id Other: Block Wall *Total new impervious area including all buildings, sidewalks, and paving: 950 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 [r *Parking(including ADA)and Lighting compliance Plan Grading Plan and details *Landscaping Plan V Erosion Control Plan and details ❑ Soils Report(if required) [ir 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 �l $.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\Permits\SIT-PermitApp.doc 08/02/2016 2 Site Work Permit Application Plan Submittal Requirements TIGARD 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 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 Clean Water Services File Number CleanWat Services 20-000315 Sensitive Area Pre-Screening Site Assessmer EC!EIVED 1. Jurisdiction: Tigard JAN 3 0 2020 2. Property Information (example 1S234AB01400) 3. Owner Information CITY OF TIGARD Tax lot ID(s): Name: Lisa and Steve Bakke TrYu&ING DIVISION 25111 BA02200 Company: Address: 9925 SW View Ter. OR Site Address: 9925 SW View Ter. City, State, Zip: Tigard , Or, 97224 City, State, Zip: Tigard , Or, 97224 Phone/Fax: 5038889397 Nearest Cross Street: 100th St E-Mail: Ibakke56@gmail.com 4. Development Activity (check all that apply) 5. Applicant Information ❑ Addition to Single Family Residence(rooms,deck,garage) Name: Lisa Bakke ❑ Lot Line Adjustment ❑ Minor Land Partition Company: ❑ Residential Condominium ❑ Commercial Condominium Address: 9925 SW View Terr ❑ Residential Subdivision ❑ Commercial Subdivision ❑ Single Lot Commercial U Multi Lot Commercial City, State, Zip: Portland, Oregon, 97224 Other Phone/Fax: 5038889397 E Mail: Ibakke56@gmail.com 6. Will the project involve any off-site work? ['Yes F. No ❑ Unknown Location and description of off-site work 7. Additional comments or information that may be needed to understand your project 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 Lisa Bakke Print/Type Title Signature ONLINE SUBMITTAL Date 1/6/2020 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. ❑ 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 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 Date 1/30/2020 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 City of Tigard 111 �t COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Commercial - With Land Use Building Permit #: '�7 (70, 3 Site Address: //gi/ ,Q /74 _ /Ay__ Suite/Bldg#: Project Name: -7773eS i1/4Pdn (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: 1 Cal f-r, 1 4/ 17-eki1 lij l z/j -e,_ czaLi____ Verify site address/suite# 'sts and active in permit syste, -�� ''ver Terrace Neighborhood: ❑ Yes No /Plarun nd Use Case#: ��l�_� �DR 201 1 -e Oo2 __ arch Approved Land Use: e Plan Landscape Plan OROther: Urban Forestry Plan evation Plan 003uilding Height: Maximum Height Actual Height ❑ nditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance Business Lic�en . Exists: ( i Yes ❑ No, applicant notified to obtain business license .IN 'ublic Facilities Improvement (PFI) Permit: Required: T Yes, applicant was notified o Applied For: ❑ Y s ❑ No, sto intakeNotes: , Approved by Planning: ' Date: 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: `0 6' Site Plans: # Building Plans: # Building Permit#: t,cEnter building permit#above. Workflow Routing: Planning L 'Engineering 56-Permit Coordinator wilding Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: 7 Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: ' By Permit Technician: Date: I:\Building\Forms\BldgPermitRvw_COM_With LandUse_060 1 1 6.doc x Engineering, Review ;l-lope at building pad: ,fZ 21PFI Permit#: A Id Conditions "Met"p 'or to issuance of building permit Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP) itir ater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes 2r-No Assess Water Quantity Fee in-lieu: ❑ Yes Er-No LIDA Facility on lot: ❑ Yes ErNo ❑ NOT Approved by Engineering: pp Date [� Notes: 426 tll AA— i •j-1-ec.� x 0 v J A�, �,a.(r.QL01-tow 4 %1--� gO, Id t-1,5 } -r- . Approved by Engineering: // 6 gN V-- Date: B i 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 ❑ C ditions "Met"prior to issuance of building permit n(y %kñate:Approved,NOT Released: 41 U ct4' t /t2/? L/3 1 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: DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes /A Tigard Trans SDC: 0 Yes /A .7" Parks SDC: 0 Yes N/A OK to Issue Permit Approved by Permit Coordinator: Date: 0 3v/Z 4.7 I:\Building\Forms\BldgPennitRvw_COM_W ithLandUse_O70915.docx Albert Shields From: Albert Shields Sent: Tuesday, October 29, 2019 5:22 PM To: Charles Moseley Cc: Caryl Pinner;Josh Harlan; Caitlin Hepworth;Agnes Lindor Subject: RE: SIT2019-00023, Jackson's Food Store#519 -- arborist report? (BCE#17856) Charles, FYI, I haven't heard from your arborist attesting that the tree protection is sufficient and in place, accordingly, I can't release the SIT. Albert Shields From:Albert Shields Sent:Thursday, October 24, 2019 5:24 PM To: Charles Moseley<cmoseley@barghausen.com> Cc:Caryl Pinner<cpinner@barghausen.com>;Josh Harlan<jharlan@barghausen.com>; Caitlin Hepworth <chepworth@barghausen.com> Subject: RE: SIT2019-00023,Jackson's Food Store#519--arborist report? (BCE#17856) I believe that Building has what they need for structural calcs for the retaining wall. I've looked over the arborist's Supplemental Report about the Urban Forestry Plan and while it does identify the trees that are to be protected it does not attest that the tree protection measures are in place and are adequate. Please have your arborist send us a letter to my attention regarding the actual tree protection measures. Thanks,Albert Shields From: Charles Moseley<cmoseley@barghausen.com> Sent:Thursday, October 24, 2019 3:16 PM To:Albert Shields<albert@tigard-or.gov> Cc:Caryl Pinner<cpinner@barghausen.com>;Josh Harlan<jharlan@barghausen.com>; Caitlin Hepworth <chepworth@barghausen.com> Subject: RE: SIT2019-00023,Jackson's Food Store#519--arborist report? (BCE#17856) Caution!This message was sent from outside your organization. Allow sender I Block sender Hi Albert: Just following up on your email. Any updates? Thanks, Charles Charles Moseley I Senior Project Manager Office:425-251-6222 I Direct:425-656-7406 Barghausen Consulting Engineers, Inc. 18215 72"d Avenue South, Kent WA 98032 www.barghausen.com From:Albert Shields<albert@tigard-or.gov> Sent:Wednesday, October 23, 2019 12:52 PM To: Charles Moseley<cmoselev@barghausen.com> 1 • Cc: Caryl Pinner<cpinner@barghausen.com>;Josh Harlan<iharlan@barghausen.com>; Caitlin Hepworth <chepworth@barghausen.com> Subject: RE: SIT2019-00023,Jackson's Food Store#519--arborist report? (BCE#17856) I'm out of the office today, Charles. I'll straighten this out tomorrow morning. Albert Shields From:Charles Moseley<cmoseley@barghausen.com> Sent:Wednesday, October 23, 2019 12:26 PM To:Albert Shields<albert@tigard-or.gov> Cc: Caryl Pinner<cpinner@barghausen.com>;Josh Harlan <iharlan@barghausen.com>; Caitlin Hepworth <chepworth@barghausen.com> Subject: RE: SIT2019-00023,Jackson's Food Store#519--arborist report? (BCE#17856) Hi Albert: We provided 3 sets of structural calcs for the retaining wall as part of the SIT permit,which was submitted to the building division. We also submitted 3 sets of the Urban Forestry Plan—Supplemental Report (Arborist Report). Please confirm that the City requires additional structural calcs for the retaining wall and an additional Urban Forestry Report—Supplemental Report. We will get you 3 copies of the geotect. Respectfully, Charles Charles Moseley I Senior Project Manager Office:425-251-6222 I Direct: 425-656-7406 Barghausen Consulting Engineers, Inc. 18215 72nd Avenue South, Kent WA 98032 www.barghausen.com From:Albert Shields<albert@tigard-or.gov> Sent: Monday, October 21, 2019 12:48 PM To:Charles Moseley<cmoseley@barghausen.com> Subject: RE: SIT2019-00023,Jackson's Food Store#519--arborist report? Charles, I just learned that Agnes will be out of the office all this week. Would you please arrange to have a copy of the arborist's report sent to me? And, FYI, Engineering has noted that a geotech report and wall calculations will need to be submitted to the Building Division. Thanks,Albert. From:Albert Shields Sent: Monday,October 21, 2019 12:30 PM To: Charles Moseley<cmoselev@barghausen.com> 2 • Cc:Agnes Lindor<agnesl@tigard-or.gov>;Allyson Armstrong<AllysonA(a@tigard-or.gov> Subject:SIT2019-00023,Jackson's Food Store#519--arborist report? Charles, I'm looking at SIT2019-00023 which says not to issue until tree protection is up and an arborist's letter is received. DDR201-900002 Condition 1 has the same requirement. Since we have not yet received them I'll put this application on hold as "Approved (for Plan Review) but Not Released". Plan Review will proceed but the permit will not be issued until the required tree protection is up and confirmed by an arborist's letter. Please let me know if you have any questions. Albert Shields Permit Coordinator City of Tigard Albert@tigard-or.gov 503-718-2426 DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 3