Permit Support Document City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
ihRequest for Permit Action
T 1 G A R iD 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: ❑ Owner ❑ Applicant ❑ Contractor ity 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 (✓):
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#: Fp5 l i '7-U O l -
Site Address or Parcel#: l/I�) JJ AtG,74
Project Name: a c-st t ,c_a;
Subdivision Name: Lot#:
EXPLANATION: '/7 rn,f -C (a,va ,-i J -Y' J c)W14
Signature: Date:
Print Name: ���,�1
Refund Policy 6
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 Li iriat By 7. Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date N1124ZL By tkJ Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518. oc
33Milding Permit Application
Fire Protection System RE .EI_ 1 FOR OFFICE ESE OS LA
City of Tigard Received
Ill g q Date/By: 0 O h a Iaf" Permit No.: , ,
g 13125 SW Hall Blvd.,Tigard,OR 97223 rt. A 1 Z017 �� •
z g Plan Review
Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit: `,2 _cdr�
InspectionLine: 503.639.4175 DateRead B Juris: _e t�f `�� 'l�
TIGARDCITYOFTIGA Y Y SeePentalI for
Internet: www.tigard-or.gov CITY x Notified/Method: " i Supplemental Information
i s t a
®New construction El 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
i. cA`EGOS wor m tcated on this application.
� �(?1�I� � k. d.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB IIINF MATT TIO Total number of floors:
Job site address:46444*SW Pacific Highway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: n/a Project name:- a.ad 1?t &c 1 Covered porch area: square feet
Cross street/directions to job site:SW Coronado&SW 65th Ave Deck area: square feet
Other structure area: square feet
§ fyroh ii ipy r --, mono,x N !9 "`1m
Subdivision:n/a Lot no.:06200 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1S136AD Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
1 (1. � BSI work indicated on this application.
New Construction of a 81,990 GSF,649 Unit,Self Storage Rental Facility with Valuation: $ y99�AUU.UQ,;. C) SVO
(associated parking,utilities,and landscape. Existing building area: 0 square feet
The previous building is being demolished through a separate permit. New building area: 81990 square feet
'ERTY Q I ,R r
FF^ rigiggA
,r [ >14" .. I ; Number of stories: 3
Name:Tigard&Pacific LLC Type of construction: IIB
Address: 1245 Brickyard Rd Ste 70 Occupancy groups:
City/State/ZIP:Salt Lake City,UT 84105 Existing: n/a
Phone:(503)974-4i248�� Fax:( ) New: S-t
, A cAN I CONTACT P&Sf]►11 1 1 ,1
Business name:Get Space All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Hoard
Contact name:iiyle-Phrrtt+'rr— � � g
under ORS 701 and may be required to be licensed in the
Address: 1700 Main St#208 jurisdiction in which work is being performed. If the
City/State/ZIP:Washougal WA 98671 applicant is exempt from licensing,the following reasons
apply:
Phone:(801)_:03 4272 • 5550_4 E pee Fax: :( )
E-maiL_kx.getsp'3"ce.com 9 Le G, gQJcE. ,c,:),NN
Business name:Perlo Construction i9..., , . tat
•( Address: 16101 SW 72nd Ave Permit fee:
State surcharge(12%of permit fee):
City/State/ZIP:Portland OR 97224 —
FLS plan review(40%of permit fee):
Phone:(503)624-2090 Fax:(503)639-4134 (Due upon application submittal.)
CCB lie.: 189245 Total permit fees:
Authorized signature: �.
Amount received:
�rint name:���
'
�r�A/k Date: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:u3uilding\Permits\FPS-PermitApp_031016.doc 440-4613 T(I 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
aetCE;
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
® New system Number of sprinkler heads: Number of alarm devices:
El Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Ty e o ( ;app c ble :
y yryyyid Sr y
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ® Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
•l S t
Hood Project Valuation: $
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
R ,� i8
rg�
�
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Project valuation subtotal (see A,B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FI,S Plan Review (40% of permit fee): $
TOTAL: $
/Users/kylenorton/Dropbox(Get Space)/TPAC Ideate/2c-Building Permit Applicatioi 'Fire Protection-Fire Supply Line PermitApp.doc
1
Inspections Required for Permit No.: j 2( 7 -
IVR Code Type Permit Description IVR Code Type Permit Description
01 BUP Building—structural 07 SIT Site Work
02 ELC Electrical 08 SWR Sewer Connection
03 ELR Restricted Energy 09 FPS Fire Protection
04 MEC Mechanical 10 RER Re-Roof
05 MST Master—residential combination II CMS Commercial Manufact. Structure
06 PLM Plumbing 12 SFM Single-Family Manufact. Structure
J Req'd Code Inspection Description ✓ Req'd Code Inspection Description
Building (structural) Inspections Electrical Inspections
205 Footing 105 Underground/slab cover
210 Foundation walls 110 Temporary electrical service
215 Footing drain 115 Electrical service
220 Slab 120 Electrical rough-in
225 Post/beam structural 125 Wall cover
230 Underfloor insulation 130 Ceiling cover
240 Exterior shearwall 135 Low voltage rough-in
242 Interior shearwall 140 Sign installation
245 Firewall 145 A/C or heating unit circuit
250 Roof nailing 150 Hot tub/spa/pool
255 Wtr proofing basement walls 195 Misc. inspection
260 Tilt-up panel 198 Low voltage final
265 Masonry 199 Electrical final
270 Reinforcing steel(rebar)
275 Framing Mechanical Inspections
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough-in
289 Approach/sidewalk 620 Hydronic piping
295 Misc. inspection 625 Duct work
299 Final inspection 630 Fire damper
635 Smoke detector shutdown
,..Fit Protection System Inspections 640 Exhaust hood
901 Sprinkler supply lines 645 Grease duct test
.,„„--943.5 Sprinkler underfloor/slab 695 Misc. inspection
4r' 906 Flush test 699 Mechanical final
� 7 Sprinkler hydro test
910 Sprinkler rough-in/test Plumbing Inspections
915 Fire alarm rough-in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc. inspection 312 Backwater valve
99$ Alarm final 315 Post/beam plumbing
999 Sprinkler final 320 Plumbing rough-in
322 Shower pan
Site Work Inspections 330 Water service
405 Excavation 335 Rain drain
410 Fill 340 Storm sewer
415 Grading 345 Culvert/catch basin
495 Misc Inspection 350 Septic tank
499 Final Inspection 395 Misc. inspection
399 Plumbing final
Sanitary Sewer Inspections
505 Sanitary sewer
Erosion Control Inspections 585 Misc. inspection
750 Initial erosion control 599 Final inspection
752 LIDA on-site facility inspection
755 Regular erosion control Manufactured Structure Inspections
797 Final LIDA inspection 810 MFG-Structure set-up
798 Final erosion control 899 MFG-Structure final
I:\Building\Forms\Inspection Cards\AOP Insp Card By Case\InspCard_All_031816.docx
S ru AAI alitri man i"
ENGINEERING
LETTER OF TRANSMITTAL
DATE: 3-1 Pj l PROJECT NO.: ( 2I \ . 1(
PROJECT NAME: - /"t
ATTENTION:
TO: ( { Q.
E�t21vtR -ter
` c1/1,1422
ENCLOSED: Plans I I Copy of Letter
Calculations I I Specifications
I Shop Drawings Other
NO. OF COPIES: DESCRIPTION:
fr-D-ktr-cki ryt
Ce)( 44d �- .r 4-)
CST
[l For your approval A
For your review
L For your use As you requested
REMARKS: Please call us if you have any questions.
COPY TO:
SIGNED:
Delivered Via:
Courier I 190 min. I 13 hr. I I Same day
I I FedEx I I Priority I I Standard
Mail
I I To be picked up
Delivered
4875 SW Griffith Drive I Suite 300 I Beaverton,OR 197005
503.620.3030 I tel 503.620.5539 I fax w w w . a a i e n g . c o m
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
FIG A R 1) 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 ity 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 (✓):
EKANCEL/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#: 3-Era?)17—uc)O .1
Site Address or Parcel#:
Project Name: Zr"�
I
f Subdivision Name: Lot#:
EXPLANATION: eZo / 7 ,„,r-,,t L JaJ ( C Aivi=// /iv Ten 5 L)7%c-e.
P i.,r-
—
Signature: �•.. Date: 177514,101
5`�a
f Print Name: rzi../.4
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 N/ S/,t.. By 29,E Route to Records: Date By
Refund Processed: Date / By Invoice Processed: Date By
Permit Canceled: Date Mt t.%1/L. By 040 Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518.doc
E
A3
•
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Building Permit Application
Commercial — 5s--r V.So044 FOR OFFI('E l SE ONLY
City of Tigard ReceivedMillirlig, II
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 9722lx-ficy,,,Islti)
Plan Re0Phone: 503.718.2439 Fax: 503.598.19 Date/B : illiai1tE�� 41, Other Permit: i 40,-,, ,
T I G A R D Inspection Line: 503.639.4175 ,1 d�, t. Date Rea' . r. See 'age 2 for
Internet: www.tigard-or.gov JU . n Notified/Method: PMSupplemental Information
�
. ,4 a w TYPE O `i � . REQUIREDifAT,Ai;i 2-FAMILY
�� Permit fees*are based on the value of the work performed.
®New construction 0 i� ��,� e p
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
uf.,., f ' 18Y, �IsI� I .; s3.}:
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder 0 Other Number of bathrooms:
Total number of floors:
ii , 1iii4 ""srt ti oo tits ANp►:A;oe N ;,�
'd/ Job site address:J.1. 19 SW Pacific Highway New dwelling area: square feet
il City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
flSuite/bldg./apt.no.:n/a Project name ard-&-PattRe (y»,C Covered porch area: square feet
Cross street/directions to job site:SW Coronado&SW 65`'Ave Deck area: square feet
Other structure area square feet
Subdivision:n/a Lot no.:06200 Permit fees*are based on the value of the work performed.
+
Tax map/parcel no.: 1S136AD Indicate the value(rounded to the nearest dollar)of all
, equipment,materials,labor,overhead,and the profit for the
3,,.k r DESt RI ON OF "" " " ( Pwork indicated on this application.
New Construction of a 81,990 GSF,649 Unit,Self Storage Rental Facility with Valuation: 9 i5 WOi i
associated parking,utilities,and landscape. Existing building area: 0 square feet
The previous building is being demolished through a separate permit. New building area: 81990 square feet
1 .r". °' PROPERTYOWNER , .r-0 A .< ., Number of stories: 3
Name:Tigard&Pacific LLC Type of construction: IIB
Address: 1245 Brickyard Rd Ste 70 Occupancy groups:
S City/State/ZIP:Salt Lake City,UT 84105
Existing: n/a
Phone:(503)974-4248 Fax:( ) New: S-1
Oi ;�� ) APPL1tANT s-"� 1a
re CONTACT • •(11�1 fte < ��4 ., B.=,l � -,' , ix ,
.) Business name:Get Space "� " ° '` �, .
r) Structural plan review fee(or deposit):
Contact name:-Kyle-Porten OA0=0,_ L yr-
"7 FLS plan review fee(if applicable):
Address: 1700 Main St#208
Total fees due upon application: 131 i 3C1
rff-
City/State/ZIP:Washougal WA 98671
Phone: O'4 al 1-65.0-6(0 Fax: :( ) Amount received
E-mail: �C,�G�'r�jPAGE.(On ` retO <,_ O TA`I , . , 0::A EL STEMF *:,, '-
x .. 7; ^ y Commercial and residential prescriptive installation of
4��' r.�� <,�. ?. . „ roof-top mounted Photovoltaic Solar Panel System.
Business name:Perlo Construction Submit two(2)sets of roof plan with connection details
nd and fire department access,along with the 2010 Oregon
. Address: 16101 SW 72 Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Portland OR 97224 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)624-2090 Fax:(503)639-4134 State surcharge(12%of permit fee): $21.60
CCB lie.: 189245
Total fee due upon application: $201.60
Authorized signature: q_ This permit application expires if a permit is not obtained
V VW- within 180 days after it has been accepted as complete.
Print name:.ytelt61�n OW t i`I J Date: * Fee methodology set by Tri-County Building Industry
���� Service Board.
;/till
P#fr'!i l:ABuilding\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I1/02/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: - 3(p i cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) (Ne c•'T) (.p1(p 33 cu.yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90%of maximum density) Z cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 2 c1 H 131 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 ❑ *Parking(including ADA)and Lighting
compliance Plan_E Grading Plan and details *Landscaping Plan
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 Vla Bit is Permit Fee:
(New,Additions or Required at s.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.
S 100,000.01 and over $809.42 for the first$100,000.00 and
$4.49 for each additional$1,000.00 or
'r, fraction thereof.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 2
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iIN ill
III le Site Work Permit Application
Plan Submittal Requirements
Ti 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. ❑ 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:ABuilding\Permits\SIT-PermitApp.doc 08/02/2016 3
w y
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