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Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 11 Ir Request for Permit Action ,, ,,,ARE) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: El Owner El Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO• (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: (I T'T-1 j i 7--doom Site Address or Parcel#: //(AL/ U :S) In442 ew- Project Name: "217 % LSVjrzter Subdivision Name: Lot#: EXPLANATION: v'tc3/7 / vri.j' u..s34 .w 7 M 'S d 2 L e_ ,ZxP, 17 AYh, Signature: Date: t//j�,r�. Print Name: - (7J Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date t{/sid.,?,. By 16 Route to Records: Date By Refund Processed: Date I By Invoice Processed: Date By Permit Canceled: Date Ai VA ZL By Ail Parcel Tag Added: Date By I:\Building\Forms\RegPemutAction_1 0518.doc • Building Permit Application Site Work RECEIVEDFOR OFFICE I;'l O\I l `J gCI of Ti and Received 4 Date/By: / i 5/ I Permit No.: 6/role,/7-000 9 IIIII13125 SW Hall Blvd.,Tigard,OR 97223. Plan Review ' I Phone: 503.718.2439 Fax: 50 l';t .. Other Permit: 5 ���� Date/BY: 10 � 6 J � v T I G R 1) Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for Internet: 1•y www.tigard-or.govr,( OF TIG.ARD Notified/Method: Supplemental Information ll 1l 11611AANUIV1SION REQUIRED DATA:l-AND 2-FAMILY DWELLING XNew construction 0 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. ❑ 1-and 2-family dwelling jg Commercial/industrial Valuation: $ ❑Accessory building El Multi-familyNumber of bedrooms: ❑Master builder ❑Other: Number of bathrooms: 114(o JOB SITE INFORMATION AND LOCATION Total number of floors: Job siteaddress: H 1®i j"\i ,I \A2K.1er g., Q�/4_ New dwelling area: square feet City/State/ZIP: 1-10 o v g'', 5 122 ,` Sr Garage/carport area: square feet Suite/bldg./apt.no.: Project name:.211 S i-7 S]CIZTIP let I Covered porch area: square feet Cross street/directions to job site: j 1 top / it '?�-1) ' ) 1 t&© Deck area: square feet ''iN j...4- -- 43 L. V A Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ 1 , J d _ ' 2 5 , , ,,to co. y-74x A .2,S OD -ry--ic C.0iS U01O6, l �OD cP al Existing building area: square feet 9;4 ,.2.,L - '7 New building area: I (?�1 square feet PROPERTY OWNER 0 TENANT Number of stories: 3 j,�" Name: ,N-1.-wtscifi.1- paz e,2-r, ,j V),�1 Type of construction: ,, `1' t,.; Address: gd2 ?�4P , .Uri Occupancy groups: g- , City/State/ZIP: P ' '~ .,� I-Oi.-4N /.1C.. i A-a Existing: t Phone:((';'N 2) ',::,..7 *-'R.T.. 1 ilk-- Fax:(b 1`�) s77 - 6"ran i New: ❑ APPLICANT CONTACT PERSON NOTICE Business name: Wti NT 1Ar6ti 7/�1Fet#7l-li Cp,M pA I.)Li All contractors and subcontractors are required to be Contact name: ID p„V Q 6�6wN licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the rJ Address: gb 2, to -3 a 0 A'J'. jurisdiction in which work is being performed.If the City/State/ZIP: P��N�l/ / Az. gs"pa 3 applicant is exempt from licensing,the following reasons - p Q apply: r1 Phone:(/o02) F�c- 5bl4- Fax::(�po2) 578 6gZ I , E-mail: CONTRACTOR ^-) Business name: Ts 0 BUILDING PERMIT FEES* t) Address: (Please refer to fee schedul J ,'; City/State/ZIP: Structural plan review fee(or deposit): FLS plan review fee(if applicable): Phone:( ) Fax:( ) J, 4/ 7.9 7 CCB lic.: Total fees due upon application: 3 I V s4lu g A(ZGLI 1 rEe Amount received: Authorized signs1 J 445a,J p permit("��S f / This permit application hcation expires if a is not obtained within 180 days after it has been accepted as complete. Print name: D - 6,NNJ Date: p g 45.2O(7 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\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: 2, G So cu.yds. Grading Volume: (Soils report required for>5,000 cu. yds.) 2 9 co cu.yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 90%of maximum density) qD o cu.yds. Retaining structure? (Check one) ❑ .Rock ❑ CMU . ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: 70 3�j �` 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: 0 Site Plan with Vicinity Map showing ADA E *Parking(including ADA)and Lighting compliance Plan Et Grading Plan and details 11 *Landscaping Plan [r Erosion Control Plan and details [✓Soils Report(if required) ❑ 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 $.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. 1:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2 INSite Work Permit Application Plan Submittal Requirements T I G A R D 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. a map &tax lot# © project name © site address Er suite number © zoning Er-applicant name Cl-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. 1:\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