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Permit CITY OF TIGARD SITE WORK PERMIT f COMMUNITY DEVELOPMEN Permit #: SIT2011 -00006 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/21/2011 Parcel: 2S110DB01700 Jurisdiction: Site address: 15290 SW PACIFIC HWY Project: Black Rock Coffee Shop Subdivision: 1996 -010 PARTITION PLAT Lot: 2 Project Description: Site work for placement of commercial manufactured structure for a coffee drive -thru. Contractor: OWNER Owner: JESS WETSEL 10110 SW NIMBUS AVENUS SUITE B -9 PORTLAND, OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee - Site Work 07/21/2011 $944.12 Plan Review 06/28/2011 $613.68 Type of Use: COM 12% State Surcharge - Building 07/21/2011 $113.29 Class of Work: NEW Plan Review - Fire Life Safety 06/28/2011 $377.65 Project Valuation: $130,000.00 Erosion Control 07/21/2011 $80.00 Erosion Plan Review CWS 07/21/2011 $26.00 Erosion Plan Review COT 07/21/2011 $26.00 Site Specifics: Excavation Volume: cu. yd. Fill Volume: cu. yd. Impervious Surface: 7668 sq. ft. Engineered Fill: Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Storn Drains: Yes Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: Total $2,180.74 Required Items and Reports (Conditions) 1 Ersn Cntrl 503 - 681 -4444 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 direct questions to OU by calling 503.232.1 • : • .800.332.2344. Issued By: / � °ermittee Signature: 'r Call 5r ' by 7:00 a.m. for the next available inspe ion 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 MT / FOR OFFICE USE ONLY City of Tigard RECEIVED Date /B d to Permit No : 5,,T2 ,. pet)0 v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review i 7 r I Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 i 1 Q Date/B : , / O�Q.Z, Inspection Line: 503.639.4175 J u N 24; 2011 Date Ready :} n \ Juris: H See Page 2 for T[GARD Notified/Method: G "' U. Supplemental lemental Information JAN A . l& . ._ . -- TYPE OF .1VPl! ' ) 7 SION . REQ , DATA: 1- AND 2- FAMILY DWELLING Permit fel' ED are based on the value of the work performed. 51 New construction ❑Demolition p Indicate the value ( rornded 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 ❑ Multi- family Number of bedrooms: 1:1 Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: Pitc;Kr New dwelling area: square feet City /State /ZIP: ri yard ` OR f 7 a L/ Garage /carport area: square feet Suite/bldg. /apt. no.: J Project name: 04 k R Covered porch area square feet Cross street/directions to job site: ` S (, Pat,' gi c F-lt9h way a /- Deck area: square feet 5 Li tiq e V Y 5 f Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 2 S 11 ©0 l f �� 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. • G-ca4 9t9 / Pal/ l'/l I In. f-a 11, S/ f -e J!•J 1-1.0, Valuation: $ ! © 00 CGtrb j Rh / Lgn ca pin Existing building area square feet ` . New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: M k/ I 7' j L L C Type of construction: Address: f O / iQ %' w 4/ f'm 12 us Ake f k, ft , - q Occupancy groups: City /State /ZIP: Dorf /ir, d ! 0 le q7 '223 Existing: Phone: ( 373 7417. Q 5 ' Fax: ( ) New: ❑ APPLICANT ,. ❑ CONTACT PERSON' NOTICE Business name: 13 /ac k Rock Coffre ear All contractors and subcontractors are required to be Contact name: �u f�� L �+ f � �� licensed with the Oregon Construction Contractors Board j under ORS 701 and may be required to be licensed in the Address: 74121 S t✓ f c lfo c T jurisdiction in which work is being performed. If the City /State /ZIP: �'� ���/ / o w 6172 v( applicant is exempt from licensing, the following reasons apply: Phone: ( 3 t - 9 p?" Fax:: ( ) E -mail: john itSticc h® t`naf/ •cam CONTRACTOR Business name: fame of /1-pf71 i cam 7 BUILDING PERMIT FEES* Address: (Please refer to fee. schedule) Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lie.: 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: Date: * Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits \SIT -PermitApp.doc 10/01/09 440- 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),gor 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: 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) cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site U ' ' .. • s Plumbing Work: Complete the • ..• bing Permit Application for site utilities work. Plans Required: See ` ork Permit Applicatio lan Submittal Requirements" attached. The following must accompany t 1 . ati • . ❑ Site Plan with Vicinity Map show' g AD • I *Parking (including ADA) and Lighting compliance Plan ❑ Grading Plan and d- . ils ❑ *Landscaping Plan - ❑ Erosion Contr. 'lan and details ❑ Soils Report (if required) ❑ Retainin : ructures *Does not . pply 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 - Occupancy 3 $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 03/03/2011 2 Site 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. ❑ 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 . ro ect location. 2. BUILDING PLAN submittal requirement: Two (2) complete sets, Civil only. All details listed below shall be incorpora e• ' I - 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 03/03/2011 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 03/03/2011 4