Permit CITY OF TIGARD SITE WORK PERMIT
111 q
COMMUNITY DEVELOPMENT Permit #: SIT2009 -00012
T t G AR L7 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 2S102BD03200
Jurisdiction: Tigard
Site address: 13075 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Sanchez
Project Description: Install concrete parking lot.
Owner: FEES
SANCHEZ, J GUADALUPE & Description Date Amount
ZAVALA, BLANCA E, 13075 SW PACIFIC HWY
Permit Fee - COM 06/24/2009 $98.25
TIGARD, OR 97223 Plan Review 06/24/2009 $63.86
PHONE: 503 - 710 -6115 12% State Surcharge - Building 06/24/2009 $11.79
Plan Review - Fire Life Safety 06/24/2009 $39.30
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: 2560 sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Stom Drains: Yes Retaining Wall: No
Fire Underground: No Accessible Parking: Yes
Fence: No
Total $213.20
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: `g r n Permittee Signature:, 0,4 0// (
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 Applicatio r
Site Wor RECEIVED FOR OFFICE USE ONLY
I
City of Tigard JUN 2 3 2009 Received tT2,,,, 0 00 1
IN DatelBy: Permit No.: (N 1` ( - ` l
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '`
111 Phone: 503.639.4171 Fax: 503.598 OF TIGARD Date/By: Other Permit:
T I G n R D
Inspection Line: 503.639 Date Read B hr ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Not ifi ed/Method: t IC 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
E Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling (a' 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: / 3A7S 5 pee A, 1.-... 1.1 New dwelling area: square feet
City/ State/ZIP: ) P qi 2 23 Garage/carport area:, square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure areal ' o't square feet Z 5- 6 6514-
REQUIRED DATA�.I RCIAL -USE CHECKLIST
LIST
Subdivision: I Lot no.: 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, d �he�r� fit a
DESCRIPTION OF WORK work indicated on this application. (X�CJ
Valuation: $ r90 /
/,.-. 9,C jerktj eft, .4
Existing building area: IA square feet
New building area: quare feet
-
['PROPERTY OWNER ❑ TENANT Number of stories:
Name: ,.... f * � / / t� t Type of construction: Address 0 5,j i.10 C `/,, , 4) L. 1 _e _ Occupancy groups:
City /State/ZIP: /' 4 _ ,,,,,,/ d / /77-7 3 Existing:
Phone: (S�) _ ( , j / S - Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
. apply:
Phone:( ) Fax::( )
E -mail:
CONTRACTOR
Business name: Aka ,gyp A ill �,, eau., n1, L L t -C BUILDING PERMIT FEES*
Address: / (Please refer to fee schedule)
a 13 77 r2/14.c I ee A k 9 70 Structural plan review fee (or deposit):
City/State/ZIP: 4
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Phone: ( ) F es: ( ) FLS plan review fee (if applicable):
�3 �[ , -' Total fees due upon application:
CCB tic.: f 4 1 . ? 4 (0 7 1 A "3 0 I 6
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
Print name: Date: F within 180 days after it has been accepted as complete.
Fee methodology set by Tri -County Building Industry
Service Board.
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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: ZS 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 applic tion:
❑ Site Plan with Vicinity Map showing E *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
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li a Site Work Permit Application
Plan Submittal Requirements
T l 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: 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
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protection. l
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
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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.
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