Permit CITY OF TIGARD SITE WORK PERMIT
$111 • ' COMMUNITY DEVELOPMENT Permit#: SIT2020-00010
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/14/2020
Parcel: 2S101CA00500
Jurisdiction: Tigard
Site address: 13500 SW WALL ST
Project: Potso Dog Park Subdivision: 2007-064 PARTITION PLAT Lot: 2
Project Description: Install erosion control measures,pave gravel parking lot and provide two accessible parking stalls.
Contractor: LEE CONTRACTORS LLC Owner: TIGARD, CITY OF
PO BOX 896 ATTN:CITY MANAGER
BATTLEGROUND, WA 98604 13325 SW HALL BLVD
TIGARD,OR 97223
PHONE: 360-852-2317 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/13/2020 $443.70
Plan Review 05/11/2020 $288.41
Type of Use: COM 12%State Surcharge-Building 05/13/2020 $53.24
Class of Work: OTR Info Process/Archiving-Sm$0.50(up to 05/13/2020 $9.50
11x17)
Project Valuation: $38,000.00 Erosion Control w/Development 05/13/2020 $107.60
Site Specifics:
Excavation Volume: 60 cu.yd.
Fill Volume: 62 cu.yd.
Impervious Surface: 0 sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: Yes
Landscaping: Yes Site Prep: No
Storn Drains: Retaining Wall: No
Fire Underground: Accessible Parking: Yes
Fence:
Total $902.45
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 -t forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OU calling 503.232.1':7 or 1.800.33 344.
Issued By: -,WC /0 / �ermittee Signature: � r
/` '
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 Tigard
Cityof Tigard RECEIVED Received �/ 7� /� �q
b Date/By: //.y/� 4e Permit NN�i T� 7, —fX)c 1O
" 13125 SW Hall Blvd.,Tigard,OR 97223 AP R 2 1 2020 Plan Review
F � Other Permit:
Phone: 503.718.2439 Fax: 503.598.196uDDate/By: v .
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Reedy/By: �/ rwis: H See Page 2for
Internet: www.tigardor.gov BUILDING DIVISION t$61Ifie �j .l Supplemental InformationZ �
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ®Other: Parking Lot Paving equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling IXJ Commercial/industrial Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13500 SW Wall Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Potso Dog Park Improvements Covered porch area: square feet
Cross street/directions to job site: From Hall Blvd head SE on Hunziker St and Deck area: square feet
then turn south onto Wall St. Site is near terminus of Wall St. 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.: 2S 101 CA00500 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.
Install erosion control measures, pave gravel parking lot, Valuation: S 38,000
and provide two accessible parking stalls. Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: City of Tigard Type of construction:
Address: 13125 SW Hall Blvd Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing: Parking Lot
Phone:( 503) 718-2466 Fax:( ) New:
IA APPLICANT 0 CONTACT PERSON NOTICE
Business name: City of Tigard All contractors and subcontractors are required to be
Contact name: Jeff Peck licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13125 SW Hall Blvd jurisdiction in which work is being performed.If the
City/State/ZIP: Tigard, OR 97223 applicant is exempt from licensing,the following reasons
9 apply:
Phone:(503) 718-2466 Fax::( )
E-mail:jeffp@tigard-or.gov
CONTRACTOR
Business name: 1,.r Cr4^,'fi/"ct, BUILDING PERMIT FEES*
Address: P2 01 a'> .^ 7,Z { (Please refer rofee schedule)
,[ -` f q Structural plan review fee(or deposit):
City/State/ZIP: /rX.v Z' G foU K/� "✓ ' ?Rea y
/ FLS plan review fee(if applicable):
Phone:(Z66 �/�' „2. 7/ 7 Fax:( )
CCB lie.: /4 V 4—I /� /�Z Total fees due upon application:
t Amount received:
Authorized signature: 1„ „1 Q.C: Z This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Jeff Peck Date: 4/20/20 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pemvts\SIT-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: 80 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) 62 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 0 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:
x❑ Site Plan with Vicinity Map showing ADA ❑x *Parking(including ADA)and Lighting
compliance Plan see site plan
0 Grading Plan and details x❑ *Landscaping Plan
x❑ Erosion Control Plan and details ❑ Soils Report(if required) n/a
❑ Retaining Structures n/a
*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 Soo 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:1Building\Pennits\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
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.doc 08/02/2016 4
City of Tigard
II1111111
C COMMUNITY DEVELOPMENT DEPARTMENT
.
TICARD Building Permit Review - Commercial - No Land Use
Building Permit #: -S / Two D-0 - 000 I O
Site Address: ( 55(;0 SW WALL T. Suite/Bldg#:
Project Name: Pb-I-so F-
(Name of commercialleusiness occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Pfik'Ve.., 2X.1011 pa -(vi 101
Existing Business Activity: Cpyrl rru h IAA
Se/nuts
Proposed Business Activity: t M
•Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: E Yes OC No
. -zoning. p R
Permitted Use: ,K.Yes ❑ No ❑ Spec Space
., ' Confirm no land use required.
Ws-Business License:
Exists: p❑ Yes 0 No,applicant was provided a business license application
Notes: � • 0 . 140.040. B ', .- YID LGIrrccU c heGiUU124 •
Approved by Planning: ArCWa /,A_ Date: +f 23/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved 0 Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: y/%Zr/7-0
Site Plans: # 3
Building Plans: #
Building Permit#: 9--Enter building permit#above.
Workflow Routing: Er--Planning 0 Permit Coordinator I wilding
Workflow Sign-off: CI Sign-off for Planning(include notes from planning review)
Route Application Documents: �uilding: original permit application, site plans, building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 0 43e,..,.....4....„__
Date: ��f'/�
L•\BuildingWonns\BldgPennitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building pe t
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Apo;cant:
Revision Notice 2: Date Sent to % .plicant:
Revision Notice 3: Date Sent • Applicant:
❑ SDC Fees Entered: Was• o Trans Dev Tax: ❑ Yes ❑ N/A
T •.rd Trans SDC: ❑ Yes ❑ N/A
arks SDC: ❑ Yes 0 N/A
O OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_N oLand U se_11 18 I9.docx