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Permit
Eikr City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT IP Request for Permit Action • Vio /y//y •• . TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.g v TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPer[nits @tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor gi City Staff Check(1)one REFUND OR Name: ! INVOICE TO: (Business or Individual) v/4 Mailing Address: / City/State/Zip: Phone No.: PLEA = :I ACTION FOR THE ITEM(S) CHECKED (1): /� • /VOID PERMIT APPLICATION. '1 UND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: .611-010/2 -000P-0 Site Address or Parcel #: 7/'/$ j 3 J 7,4d„.1- 67- PA-04_,,,12,Project Name: --P406 f Ls ��/J-4teCE s 5oZt/ Lo r✓Subdivision Name: / Lot#: EXPLANATION: V o,-p �9�2M -r- kS P*QK t,.� LT Pal F CT i2CAA C-€7D i t Tit - r 4z sAAJ L 1I2‘..0 to-7.01r x;5--000A ND Pau L.-DgJea r«�s P� ,SHE —cJz..y 71& . Signature: Date: !o%/,q Print Name: j_M i A ,,q-9'{S k I 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. FOR OFFICE USE ONLY Route to S s Admin: Date !OIN/e: B' ;2, Route to Records: Date &AM B' ir.tng Refund Processed: Date ift- By Invoice Processed: Date By Permit Canceled: Date /oh y y By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_( 2314.doc ' � 4 CITY OF TIGARD SITE WORK PERMIT �'1 a COMMUNITY DEVELOPMENT Permit #: SIT2012 00020 Date Issued: 12/12/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S101AC00800 Jurisdiction: Tigard Site address: 7148 SW GONZAGA ST • Project: Rogers Subdivision: BEVELAND NO 2 Lot: 14 Project Description: Site work for non - accessory parking lot . Contractor: CENTREX CONSTRUCTION INC Owner: ROGERS, ROY R 8250 SW HUNZIKER RD 13690 SW TWELVE OAKS CT TIGARD, OR 97223 TIGARD, OR 97224 PHONE: 503 - 684 -0443 PHONE. FAX: 503 - 620 -6692 FEES Description Date Amount Specifics: Permit Fee - Site Work 12/12/2012 $701 82 Plan Review 10/17/2012 $456.18 Type of Use: COM 12% State Surcharge - Building 12/12/2012 $84 22 Class of Work: NEW Info Process /Archiving - Lg $2 00 (over 12/12/2012 $14.00 11x17) Project Valuation: $80,000 00 Erosion Control Only - Ping 12/12/2012 $300 00 Site Specifics: Excavation Volume 80 cu yd Fill Volume: cu. yd. Impervious Surface: 4860 sq ft Engineered Fill: Soil Report Required: Paving Yes Grading: Yes Landscaping Site Prep: Storn Drains Retaining Wall: Fire Underground. Accessible Parking: Yes Fence. Total $1,556 22 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 • if wor suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility otification 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 d ect questions to OUNC b • - lin. : .232.1987 or 1 800 332 2344 , lss ed By: : / / I 1 Permittee Signature: L ��r� . 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. Building Permit Application Site Work �r�� FoR OFFICE USE ONLY City of Tigard ""� Date/By. l Received T�a i Permit No • .r/ .4 AO /7/ ° 13125 SW Hall Blvd., Tigard, OR 97223 OCT 1 7. 2012 Plan Review Z In : Phone 503.718 2439 Fax: 503.598.1960 Date/By j�.. nJ ('Z — g - f ., Other Permit. �D 0,0/ l' I G n R D Inspection Line. 503.639.4175 (� n� Date Ready/8y \ 4 Jugs El See Page 2 for Internet www.tigard - or.gov CI TY %FTIGARD Notified/Method /a //0. 1 f Supplemental Information BUILDINGDNI! EON Si°e, 14/ /_r7 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 ( rouded to the nearest dollar) of all El Addition /alteration/replacement Other: 1_ ar k ivco Lo '- equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling ❑ Co mercial/industrial Valuation: $ Commercial/industrial El Accessory building ❑ Multi- family Number of bedrooms: El Master builder El Other: 5, - 4. e t J 1,,c. Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: - 3. ) N is 5 L./ Ga in , a 5 4-- New dwelling area: square feet City/State /ZIP: T,-. . t-c-4. j 0 K Gj ZZ'S Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: R Qy kl _ 0te..woe p4a1, Covered porch area: square feet Cross street/directions to job site: Croy , c 04...4.A. 7-? „",/ Deck area: square feet 114 t v all Piro w'- Le t. , Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: (0b$OD Permit fees* are based on the value of the work performed. no.: ndicate the value (rounded to the nearest dollar) of all Tax map/parcel wa 7 L Co O -ng +f- " P 2 . 5 tot t equipment, materials, labor, overhead, and the profit for the rJ Ada{ (n DESCRIPTION OF WORK work indicated on this application. Ate h i .e r o >L 4 . 3 00 1F1- o no - otf ottee*Perr Pwlr. Valuation: go J OUC) 1. cfr l! i 64.7 Cc. -.'( (,.../c44 e f gp L�wl (I F-0. r ;t ," {- Existing building area square feet New building area: square feet ®, PROPERTY OWNER ❑ TENANT Number of stories: Name: (L,.( Lei l er 5 Type of construction: Pd s EC i - .4. I. G 'F- Address: M'� Z �-OO SW }Z 4 v r Occupancy groups: City /State /ZIP: ¶ ar t ct J o R ail Z Z3 Existing: Phone: (503) 6 ZO - 2 b 3 Z Fax: ( ) New: [APPLICANT ❑ CONTACT PERSON NOTICE Business name: ct,, 4.r it Wog 4- µL . on She All contractors and subcontractors are required to be Contact name: / t cv G LzK 0wr licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: g, 2 6 0 51.) 14 ,......e, k R4 jurisdiction in which work is being performed. If the City /State /ZIP: �,- pr d ( C 2� 3 applicant is exempt from licensing, the following reasons 9 apply: Phone: (50 3) 4, 25 . v9t l) Fax:: (563 6ZO - b b 1 Z E-mail: 5 ve (� Ge ,A.4reo- c o tt 4 ri.t: (-col , v. a i CONTRACTOR Business name: !l- Lc y / pp I %. t ,-* BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City /State /ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): Total fees due upon application: CCB lic.: 5 (p.5.--cg ‘4h //3 Amount received: e , /1( Authorized signature: jyyyy — This permit application expires if a permit is not obtained / within 180 days after it has been accepted as complete. Print name: l j f- e u G �c ac.. ,..nr-L Date: t 0 11- (Z * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Perrnits \SIT - PermitApp.doc 10 /01/09 440- 4613T(II/02 /COM/WEB) City of Tigard: Site Work Permit Checklist `, ; s v 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 dutiipitruck"loads), or., less than 3 feet deep and will not be supporting a structure. If a building will be c onstiuoted'On the'fiill, 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: $`O cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) S o 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: c9 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: ❑ Site Plan with Vicinity Map showing ADA ❑ *Parking (including ADA) and Lighting compliance Plan ❑ Grading Plan and details ❑ *Landscaping Plan ❑ Erosion Control Plan and details ❑ Soils Report (if required) ❑ Retaining Structures ❑ Fire Line *Does not apply 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 05/25/2012 2 J 7 :.. 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 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. 1: \Building\Permits\SIT- PermitApp.doc 05/25/2012 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. (.\Building \Permits \SIT - PermitApp doc 05/25/2012 4 Dianna Howse From: Mark VanDomelen Sent: Thursday, December 06, 2012 4:52 PM To: Debbie Adamski; Dianna Howse Subject: SIT2012 -00020 7 /9 SA/ 6 t9'J2 , 9 G ' I approved this permit for post review late Friday and told the contractor that it should be ready Monday Morning. If it is issued, please work with Mike White to confirm his availability and manually schedule an EC inspection for Monday. Thanks, Mark VanDomelen Building Official City of Tigard markvPtigard- or.gov (503)718 -2448 DISCLAIMER. E -mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E -mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule " 1 Building Division Development Code Provision Review ricAR° Commercial Projects with Approved Land Use Building Permit No.: (T o 1A Land Use Casefile No.: 'D 2. Po (2-- O0 01 Routed Plans: Submittal Date: /CO 7 // 9-- C Submittal Date: Submittal Date: To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. STAFF: please only mark those items r n the left side that are approved. Plan 'ng Review (contact .i /� / at 503- 718g or g_, @tigard- or.gov) 'and Use Approval 402 32/ Buns Match Approved Pla • Yes El' No ❑ ❑ Maximum Building Height l ❑ Conditions Met Notes: /19T ` f J �`�" V41'' '/ CAW / �� 1�S a/re i;v - TAI NEOP ,/1 1% sr", f Original Plan: Approved Not Approved ;ice Date: AK ' Revision 1: Approved ❑ Not Approved ❑ Date: a Revision 2: Approved ❑ Not Approved ❑ Date: erir / 1 _ / - 4 ( 114 err Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) .Er Actual Slope: 5- ❑ PFI Permit # ❑ Conditions Met Notes: I1/4- F ( T(Ll - - t-o 19 u E Original Plan: Approved ❑ Not Approved Date: 1 U (i 6 I Z ' Revision 1: Approved Not Approved ❑ Date: 1/ ( 21 /L Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) ❑ Street Trees ❑ Protected Trees Notes: Original Plan: Approved ❑ Not Approved ❑ Date: Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) ❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit ❑ Engineering Okay to Issue Permit Notes: Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applican Revision 2: Date Sent to App • nt Okay to Issue Permit: Ye No • Date Routed to Building: Page 2 of 2 Albert Shields From: Albert Shields Sent: Thursday, October 18, 2012 4:16 PM To: 'steve ©centrexconstruction.net' Cc: Mike White Subject: SIT2012- 00020, Rogers Parking Lot Attachments: Albert Shields.vcf Steve, FYI, in reviewing your application for the site permit, SIT2012- 00020, there are issues that need to be handled before the permit can be issued by Building. Our comments are: Planning: Do not issue until Conditions [of Approval] 1— 6 are met. Engineering: Need PFI Permit issued prior to issuing the SIT. Please submit PH application. Please let me know if you have any questions. Albert Shields app Albert Shields City of Tigard Program Development Specialist Albert ®tigard- or.gov (503) 713-2420 (503) 624 -3631 Fa 1 Albert Shields From: Albert Shields Sent: Monday, November 19, 2012 6:02 PM To: steve @centrexconstruction.net Cc: Mike White Subject: SIT2012 -00020 & SDR2012 -00002 Steve, it looks to me as if your submission of 11/6 is complete. I apologize for the delay in processing. I do not know what happened to delay this but I'll do my best to have our folks move on it tomorrow. Thanks for your patience. Albert Shields. 1