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Permit M CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Permit #: SIT2010 -00013 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2010 T] ARD Parcel: 2S102CB01802 Jurisdiction: Tigard Site address: 13407 SW PACIFIC HWY Project: AutoZone Subdivision: Lot: 0 Project Description: Site work for new construction. Contractor: PACIFIC UNDERGROUND Owner: BAR -AM, LLC PO BOX 2258 BY GODFATHER'S PIZZA OREGON CITY, OR 97045 1416 THIRD AVE SEATTLE WA, 98 PHONE: 503 - 632 -3534 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee - Site Work 11/17/2010 $1,482.92 Plan Review 11/17/2010 $963.90 Type of Use: COM 12% State Surcharge - Building 11/17/2010 $177.95 Class of Work: NEW Plan Review - Fire Life Safety 11/17/2010 $593.17 Erosion Control 11/17/2010 $80.00 Project Valuation: $250,000.00 Erosion Plan Review CWS 11/17/2010 $26.00 Erosion Plan Review COT 11/17/2010 $26.00 Site Specifics: Excavation Volume: 600 cu. yd. Fill Volume: 700 cu. yd. Impervious Surface: sq. ft. Engineered Fill: Yes Soil Report Required: Yes Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Storn Drains: Yes Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: Yes Total $3,349.94 Required Items and Reports (Conditions) fia,:o c,„/TQdL 6 8/ '70L 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 or direc uestions to U calling 503.232.1987 or 1.800.332.2344. Issue By: / Permittee Signatur �/ /1 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. -1UL 19 -2010 MON 03:21 PM FAX N0, P. 02 wilding Permit Application RECEIVED c 77 ce---a00 F—G YC 7 Site W�' �gp ork rt,lt OF Fit 1. I til t >�I 2010 City of Tigard Received Date/B ,,/ et Permit No.: t �1„ ii _ _ } t-3 4 13125 SW Hall Blvd., Tigard, OR 97223 III' OF TIGAR Plan Revte . - �-!�. G ✓ /V Phone: 503.639.4171 Fax: 503,598.19 ILDING DIVISIG Date/B /�„ i!� �� � other Permit �� ��; �, ��� :I' tk, „;,i, ri Inspection Line: 503.639.4175 NNN Date Ready/ Jabs: ® See Page 2 for Internet: www,tigatd- or.gov NotifiedNethod: Supplemental Information . TYPE OF WO - REQUIRED DATA 1- AND 2- FAMILY DWELLING 0 New construction 0 IYemolition Permit fees* arc bascd 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. • Valuation: $ 0 1- and 2- family dwelling 0 Commercial /industrial _ _ 0 Accessory building 0 Multi•fatnily Number of bedrooms: 0 Master builder Q Other: Number of bathrooms: . JOB SITE :INFORMATION ETNA LOCATION:' • ' Total number of floors: Job site address: 13405 SW Pacific Highway New dwelling area: square feet City /State /ZIP: Tigard /012/97223 Garage /carport area: square feet Suitc/bldgJapt. no.: Project name: Au toZone Store No. 3756 Covered porch area square feet Cross strect/directions to job site: West of SW Pacific Highway. Deck area: square feet South of SW Park Street. Oast and North of SW Watkins Avenue. Other structure area: square feet . REQUIRED DATA COMMERCIAL -USE CHECKLIST • Subdivision: N/A Lot no.: 01802 Permit fees* are based on the value of the work performed. Tax map /parcel no.: R994507 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. l Valuation: $$250,000.00 Demo Existing Site and Building, Construct new building and accomodating site improvements. Construct Highway frontage improvments. Existing building area: 3,737 square feet New building area: 6,786 square feet �( PROPERTY', OWNER' 0 TENANT. Number of stories: 1 Name: Type of construction: Commercial Address: Occupancy groups: • City /State /ZIP: Existing: Bar -AM LLC Phone: ( ) Fax:'( ) New: AutoZone . l APPLICANT I• Q CONTACT . PERSO ' ' NOTIC Business name: AutoZone i All contractors and subcontractors are required to be Contact name: Mitch Bramlitt licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be Licensed in the Address: 123 South Front Street i; jurisdiction in which work is being performed. If the City /State/ZIP: Memphis/TN /38303 applicant is exempt froth licensing, the following reasons -.-. -. apply: Phone: (901) 495 -8714 Fax: v: ( ) The applicant is a developer, and hasn't - E -mail: mitch.bramlitt@autozone.com • d a Contractor ow ve t- - Business name: N/A Pie l r iti t . / ( i _ ,- 0 E Q 6 2 ` D • BUILDING PERMIT FEES* - Address: � ° P D X n y`j • • (Please refer to /W schedule) CityiState/Z1P: o� 010 CA jt/ oiZ - 97 a 5 Structural plan review fee (or deposit): �3 Is 3 a - 3 5 3 ( ) FI,S plan review fee (if applicable): Phone Fa CCB lie.: f 3 Total fees due upon application: KU a -/� n : I Amount received: 2 1.147 H Authorized signature: {1!I9.1�T111 This permit application expires If a permit is not obtained within 180 days after it has been accepted as complete. Print name: ` �, Rate: a Fee methodology set by Tri•County Building Industry 1 Service Board. I :113uilding\Pennits \SIT- PertnitApp,doc 10/01/09 440-4613T(11 /02 /COMJWEB) `rCU Ts S tri i w w I 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: & OO cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) (, 3 as cu. yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) — 7 0 0 cu. yds. Retaining structure? (Check one) ❑ Rock OM' CMU 01 Concrete ❑ Other: *Total new impervious area including all buildings t 7 ,� P'i fQfd/ b�J Arm 6 y sidewalks, and paving: I t o S pro ,a et e S 4 fr 2., 0 / O 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: IN Site Plan with Vicinity Map showing ADA ,0, *Parking (including ADA) and Lighting compliance Plan •© Grading Plan and details 0 *Landscaping Plan 0 Erosion Control Plan and details ❑ Soils Report (if required) Retaining Structures *Does not apply to One- and Two - family dwellings. Plan Submittal: Permit Fee: Va luation ' k' Perm><t ' Fee T;YPEO ` F SUBMITTAL # of.Plans` � • (New � , Additions or Required:at $.00 to $500.00 $51.09 minimum permit fee Altera'tions) � Subinittal $500.01 to $2,000.00 $51.09 for the first $500.00 and • $2.69 for each additional $100 or fraction Commercial 2 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 2 $10.76 for each additional $1,000 or fraction thereof, to and including $25,000.00. One- & Two - Family Dwelling 2 $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 12/27/06 2 Site Utilities — Plumbing Permit Application Plan Submittal Requirements TTGARD A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer and potable water systems on private property. 1. SITE PLAN and vicinity map showing the geographic location (fully dimensional, drawn to scale) labeled with: A. Q' map & tax lot # 0 project name © site address ©_ suite number 0 zoning '_ applicant name gy p. phone number B. North arrow. C. Scale (architectural or engineering only). D. Street names. E. Building pads with project location. 2. PLUMBING PLANS - Two (2) complete sets, civil only. All details listed below shall be incorporated into the plumbing plans: A. Storm drainage plan showing: 1) Finish elevations throughout the developed site. 2) Grade breaks determining area serving each catch basin. 3) Location of catch basins. 4) Pipe size. 5) Type of material. 6) Slope of piping. 7) Manholes and field drains. 8) Cleanouts provided for each 100 feet or fraction thereof. 9) Roof drain laterals specifying cleanouts at each upper terminal. 10) Location of existing or proposed connection to a public sewer line. B. Utilities plan showing: 1) Sanitary sewer line location, pipe size, type of material, slope of piping, manholes and cleanouts provided as required for storm. 2) Size and location of domestic water piping and drainage. 3) Proposed location of connection to a public water or sanitary sewer line. I:\Building\Permits\PLMF- PermitApp.doc 12/30/05