Permit IN CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2018-00027
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/18/2022
Parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons Food Stores 530 Subdivision: None Lot: None
Project Description: Site work for redevelopment:Includes paving,landscaping,storm water improvements,and site utilities work.
Contractor: ONSITE DEVELOPMENT Owner: PACWEST ENERGY LLC
PO BOX 3171 3450 COMMERCIAL CT
OGDEN, UT 84404 MERIDIAN, ID 83642
PHONE: 801-621-1600 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 01/18/2022 $1,797.22
Plan Review 10/22/2018 $1,168.19
Type of Use: COM 12%State Surcharge-Building 01/18/2022 $215.67
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 01/18/2022 $56.00
Project Valuation: $320,000.00 11x17)
Info Process/Archiving-Sm$0.50(up to 01/18/2022 $150.00
11x17)
Erosion Control w/Development 01/18/2022 $386.40
Site Specifics: Additional Plan Review 02/17/2022 $90.00
Excavation Volume: 500 cu.yd.
Fill Volume: 700 cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: No Soil Report Required: No
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $3,863.48
Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
2 Special Inspection(see plans)
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
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 OFF HT, I SI:ONI.l
flEIVE�`• "Received
City of Tigard Permit No.: p-
1111 13125 SW Hall Blvd.,Tigard,OR 97223 ¢ Plan Review J
II Phone: 503.718.2439 Fax: 503.598.1960 OCT r 2 U l0 Date.By: J -•a" j 4 Other Permit:
Inspection Line: 503.639.4175 y ` p v�y�y Date Read/By: ruri VI See Page 2 for
T l(,/�R D CITY F 9'1,�AR ` Notified/Method:�% _j_e'12 Supplemental Information
Internet: www.tigard-or.gov y 7
( 1 ivy JfkattbOw Li/Auk/,l r(
' 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: equipment.materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ®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: 11290 SW Bull Mountain Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Jacksons-Ner4341- fitu ,,e3. Covered porch area: square feet
Cross street/directions to job site:SW Pacific Highway/SWC of intersection Deck area: square feet
No 1 fief'/j4 �'Z. , ,u f' '''c- t3, L` j+fz_ r Other structure area: square feet
1111 z 4` "Za e711 4— . 0 YA-.;// REQUIRED DATA:COMMERCIAL-USE CHECKLIST
` Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S110AC01101 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.
6i-re 6'1 riec! 4Valuation: $320,000.00
`"-4 1.44(/. eAr t s .,,fin ,1 ®, fri t (2i14-/fik Existing building area: 6,420 square feet
New building area: 7,058 square feet
b ® PROPERTY OWNER I 0 TENANT Number of stories: 1
,m Name:PacWest Energy LLC dha Jacksons Food Stores,Inc. Type of construction: VB AND IIB
if.aiv Address:3450 East Commercial Court _ Occupancy groups:
City/State/ZIP:Meridian,ID 83642 Existing: M AND B
Phone:(208)888-6061 Fax:(208)888-3585 New: M
❑ APPLICANT ® CONTACT PERSON
NOTICE
Business name:Barghausen Consulting Engineers,Inc. All contractors and subcontractors are required to be
Contact name:Jeremy Irving 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)251-6222 Fax::( )
E-mail:jirving@barghausen.com
CONTRACTOR
Business nam•• :1
x "1 BUILDING PERMIT FEES*
Address: l�t_ j r 7' (Please refer to fee schedule)
Structural plan review fee(or deposit):
City/State/ZIP: O d� (4 c,�T oq
FLS plan review fee(if applicable):
Phone:( i)G4�t�//adj., Fax:( )
CCB lic.: ,,rA`, ,
' Total fees due upon application:
/ Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: /r`L/. ;.� A405t ,E Date: {j 2e 0 * Fee methodology set by Tri-County Building Industry
C v Service Board.
ing\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(I1/02/COM/WEB)
City of Tigard
III N COMMUNITY DEVELOPMENT DEPARTMENT
1
TIGA}zD Building Permit Review — Commercial - With Land Use
Building Permit #: , /r 0U0.67-7
Site Address: /J2,c.7 514) Bo// Af,,„le,,,, i d Suite/Bldg#:
Project Name: aGt4Son s t-ood �6 r'e5
(Name of commercial business occupying the space. If vacant,enter Spec Space.) !/ `N fji '
•
Planning Review J s 1e '
t
Proposal: i e U,0r- L. -U r LbPaorz--Dc2�0S w••rc. -hwKw r , ,7rw
17-1
Verify site address/suite#exists and active in permit system.
Ever Terrace Neighborhood: ❑ Yes 'INo
Land Use Case#: CU Po 17—c 'o d 5
Pla Match Approved Land U :
U Site Plan 0 andscape Plan ❑ Other:
WUrban Forestry Plan Elevation Plan
'�� 1ding Height: Maximum Height Actual Height
19 onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business Liceens,,,e•.,
Exists: a Yes ❑ No,applicant notified to obtain business license
ublic Facilities Improvement(PFI) Permit:
Required: 'Yes,ap%lic nt was notified ❑ No Applied For: ,B'Yes ❑ No,stop intake
Notes: 9,7 rY 7o S' 4I P ec /'iO' c� b /fir
5 �C >~'1 r7 � ,ail fcsjc?',Sc" E' /`��a� D
Approved by Planning: 'D : (D 2- ,
Revisions (after Building Submittal only) Reviewer D to
Revision 1: ,B Approved ❑ Not Approved At- 2 2022
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: La f)2'Ji V
Site Plans: # 3
Building Plans: # 3
Building Permit#: a•-tr ter building permit#above.
Workflow Routing: L5'1 i ning Bering -P I it Coordinator e-�"tt lding
Workflow Sign-off: off for Planning(include notes from planning review)
Route Application Documents: 21.1 ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: - Date: /9 fi
l:\Building\Forms\BIdgPermitRvw_COM_W ithLandUse_060116.docx
_ . m
Engineering Review
0 ope at building pad: ?ig
1'PFI Permit#: 2o/S' d.Z�_S
[ Conditions"Met"prior to issuance of building permit
Et-Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
Rater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 12-No QQ
Assess Water Quantity Fee in-lieu: ❑ Yes 0'&-o /7 L r4 a avail
�LIDA Facility on lot: I Ves ❑ No
d NOT Approved by Engineering: ✓ Date /e2A iel
//JJ
Notes: 1/G�tdtc" /CYO
Approved by Engineering: 14. it ,1442 Date: /2 ' 2;- 2-02-/
Revisions (after Builldd'ng Submittal only) Reviewer Date
Do/Approved Revision 1: ❑ Not Approved i& IF(d i4 9.0°2.40 L
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
/`J Conditions "Met"prior to issuance of building permit pproved,NOT Released: e l; G tlG / )
Notes: / ID ate: /v`3/` eO
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant: AN- Z•1 191
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant: _ I
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes "/A ( A ()Pic G4
Tigard Trans SDC: ❑ Yes yi N/A tit 1r r OU,i)7 i0(.Q'C ('5
Parks SDC: ❑ Yes I)eN/A
I K to Issue Permit r"irt
Approved by Permit Coordinator: Date: 1242 3 I 24)?A
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 070915.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN Transmittal Letter
r!c;A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: idM DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: a4ificj r9tfivG7 JAN 2 4 2022
COMPANY: CITY OF TIGARD
BUILDING DIVISIQ ,3T
PHONE: 64�-�-) G 5� - 710(o
EMAIL: 6-/`)0S(z a -/ V�A,.., c.v- cri/r+
RE: 1/ 0 54) i99/11/j'iy,..„/i,),v 4-i. ( IF-000?-7
(Site Address) (Permit Number)
GkJ0vt S f-bckil l`e-S U
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain): 62) jef3 e f 6 Lid t lzw/Af��,/�c � ale 0441-(✓,I.,S-
REMARKS: 11
FOR OFFICE USE ONLY
Routed to Permit Technician: Date: a J G'a 2, Initials: '
Fees Direig Yes ❑ No Fee Description: Amount Due:
I )-j f pc,,h r am:<_NiJ $ 90—
$
$
$
Special
Instructions:
Reprint Permit (per PE): ❑Yes No ❑ Done
Applicant Notified: 9,e,a__ Date: o /i 7iga Initials: ,',.i.
I:\Building\Forms\Transmittal Letter-Revisions_073120.doc