Permit 9 /ay /o 9 .t ... rz-/ •
III 'u. CITY OF TIGARD SITE WORK PERMIT
•ll
I
12 COMMUNITY DEVELOPMENT Permit #: SIT2009 00016
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
• , Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: ADA site improvement. 9/24/09, adding erosion control.
Owner: FEES
ROBINSON FAMILY TRUST Description Date Amount
PO BOX 91305
PORTLAND, OR 97291 Permit Fee - COM 08/11/2009 $310.80
Plan Review 08/11/2009 $202.02
PHONE. 12% State Surcharge - Building 08/11/2009 $37.30
Plan Review - Fire Life Safety 08/11/2009 $124.32
Contractor: Erosion Control 09/24/2009 $80.00
ROBINSON CONSTRUCTION Erosion Plan Review CWS 09/24/2009 $26.00
21360 NW AMBERWOOD DR Erosion Plan Review COT 09/24/2009 $26.00
HILLSBORO, OR 97124 -9321
PHONE: 503 - 645 -8531
FAX: 503 - 645 -5397
Type of Use: COM
Class of Work: ALT
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $806.44
Required Items and Reports (Conditions)
1 SIT 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 • ••• uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N, ification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dirz t questions to OUN • • :l • g 503.246.6699 or 1.800.332.2344. Issu • d /i By: k � .`/ J ' Permittee Signature: Ak
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
R7 Mi
CITY OF TIGARD SITE WORK PERMIT
g COMMUNITY DEVELOPMENT Permit #: SIT2009 -00016
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Subdivision: Lot: 0
Project: Greenburg Building
Project Description: ADA site improvement.
Owner: FEES
ROBINSON FAMILY TRUST Description Date Amount
PO BOX 91305
PORTLAND, OR 97291 Permit Fee - COM 08/11/2009 $310.80
Plan Review 08/11/2009 $202.02
PHONE. 12% State Surcharge - Building 08/11/2009 $37.30
Plan Review - Fire Life Safety 08/11/2009 $124.32
Contractor:
ROBINSON CONSTRUCTION
21360 NW AMBERWOOD DR
HILLSBORO, OR 97124 -9321
PHONE: 503 - 645 -8531
FAX: 503 - 645 -5397
Type of Use: COM
Class of Work: ALT
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: No Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $674.44
•
Required Items and Reports (Conditions)
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 -0100. You may obtain a copy of the rules
or direct questions t OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` Permittee Signature: 1p n
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 p .
Site Work � °F O USE ONLY
' ' , City of Tigard AUG 1 1 2009 Date /ea ) Permit No: 1 r�
1. : 1_• O •
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : lam aim
Other Permit: 'p _CUL •
Inspection Line: 503.639.4175 CITY OF 11GARD Date Ready / :y: Juris. See Page 2 for
TIGARD g g BUILDING DIVISIOK Notified/Method: �
Internet: www.tiard Supplemental Information
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.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION, AND LOCATION Total number of floors:
Job site address: 1 1 t t . s 1 6 a_ h V') U 14; New dwelling area: square feet
City /State /ZIP: "�T e 1 7 ' Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Y4 4 %.hj, f y% 1 Covered porch area: square feet
4 Cross street/directions to job site: Deck area: square feet
C n-' N2 e)' . j v,' d" 3(�� / M , ( ° 3\U
':4 Other structure area: square feet
L) J V') 0 5 �' � ed ��1
e REQUIRED DATA: COMMERCIAL USE CHECKLIST
Subdivision: 1 Lot no.: I la) Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 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.
�\ ,-•: � 4--.T' Valuation: $ h /�
DP D- 1 ►til y 'ye' � �` i 'J -' 4l l J WO
4 7 11:4--- uy---rz-;, a iit 0, - Existing building area:vi c I 1 square feet
New building area: square feet
PROPERTY OWNER
0 TENANT Number of stories: I.
Name: 1, ,-,--3b. 'e� '-i 0 , i ,' I IA � - Type of construction: J ^ , \ ` , g � 1 t \ - p�
Address:
(pt, Iv vv /C. .=�L �( k X � , Occupancy groups:
City /State /ZIP: , a-- Existing:
Phone: ,,rrte�; ) �' -- [ � -
<< A:r f 7 I Fax: ( �) :re New:
--
�; APPLICANT ❑ CONTACT PERSON NO
Business name: c` Di\ i , All contractors and subcontractors are required to be
Contact name: �/ licensed with the Oregon Construction Contractors Board
I�.b P i° , ' ` � � � � t � under ORS 701 and may be required to be licensed in the
Address: ti I } t t ,- r r vc 9 4- � jurisdiction in which work is being performed. If the
k f� 7 applicant is exempt from licensing, the following reasons
City /State /ZIP:
y±/ I et iek biz ci I ca \ i apply:
Phone:5 /�) i2 .. 2 <%4:, I y Fax:: 2 1 4.0 — 1 (0 _
E -mail: I JYfrV C& Cite(i ri L. . (l) t-
CONTRACTOR
Business name: [_ , )y CO "I'" ' 'ti 1,, z) 6 ,, BUILDING PERMIT FEES*
N _ (Please refer to fee schedule) • Address
( p � ;f � Structural plan review fee (or deposit):
City /State /ZIP: + I 5 ,- , 6
Phone: L ;. Fax: .. . FLS plan review fee (if applicable):
�v �� - � ) ��� 1 � ) �� 3 ' Total fees due upon application:
CCB lie.: co - 6 ] 9 -
11 Amount received:
Authorized signature:
/ � � This permit application expires if a permit is not obtained' , L n l within 180 days after it has been accepted as complete.
Print name:
/ Y - ,
�o (�� ��r .,,A.,,AF , �. Date: I ' �� * Fee methodology set by Tri County Building Industry
/ ` Service Board.
I: \Building \Permits \SIT- PermitApp.d c 12/27/06 440- 4613T(I1/02 /COM/WEB)
f f
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: �-�` 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 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 ❑ *Parking (including ADA) and
ADA compliance Lighting Plan
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.
# of Plans
TYPE OF SUBMITTAL Required at
(Includes New, Additions or Alterations) Submittal
Commercial 2
Multi- Family R -1 Occupancy 2
One- & Two - Family Dwelling 2 •
}
1: \Building\Permits \SIT- PennitApp.doc 12/27/06 2
•
Site Work Permit Application
Plan Submittal Requirements
TIGARD 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: Two (2) 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.
3) Illustrations detailing the correct installation of the silt fencing and catch basin
I:\ Building \Forms \SIT - PlanSubReq.doc 06/29/06
,
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.
1: Buildin \ Forms \SIT- PlanSubRc 06 /29/06