Permit CITY OF TIGARD SITE WORK PERMIT
,,
1111 2° COMMUNITY DEVELOPMENT Permit#: SIT2016-00001
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/18/2016
Parcel: 2S1060001801
Jurisdiction: Tigard
Site address: 17480 SW CLEMENTINE ST
Project: Clean Water Services River Terrace Pump Station Subdivision: 2002-032 PARTITION PLAT Lot: 3
Project Description: Site work for a new sanitary sewage pump station to serve River Terrace.
Contractor: ROTSCHY INC Owner: CLEAN WATER SERVICES
9210 NE 62ND AVE 16060 SW 85TH AVE
VANCOUVER,WA 98665 TIGARD, OR 97224
PHONE: 360-334-3100 PHONE: 503-547-8187
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 04/18/2016 $1,348.22
Plan Review 01/14/2016 $876.34
Type of Use: COM 12%State Surcharge-Building 04/18/2016 $161.79
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 04/18/2016 $74.00
11x17)
Project Valuation: $219,500.00 Erosion Control w/Development 04/18/2016 $311.40
Site Specifics:
Excavation Volume: 763 cu.yd.
Fill Volume: 3730 cu.yd.
Impervious Surface: 3300 sq.ft.
Engineered Fill: Yes Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking: No
Fence: Yes
Total $2,771.75
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 N• • . • enter. ••se rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You obtain cop of the rules
or dirt t questions to • • by ca ir: 503.232.1987 or 1.800.332.2344.
Iss ed By: / 4 0 ' Permittee Signature: •
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 Ls /4? 3o /S-
Site World ` '�D FoR()HA( 1. I si: O\l.1
City of Tigard � 0 V Received r/�
Q�� . /� Permit No.: ID M
114 13125 SW Hall Blvd.,Tigard,OA 9rR7S Plan Review
S Phone: 501718.2439 Fax: 503.598.196 t) O 2015 Date/B : + AI Other Permit:r'[t p ,�„C� /
l I t. \I:I) Inspection Line: 503.639.4175 Dale Ready:y: �fv_See Page 2 for
Internet: www.tigard-or.gov (�'(� �F c�GV\\9D� Notified/Method: ')_'_ Supplemental Information
a�. ITvz 7+ § i t t s
+n^ w.r � �, ` `�t�� � � _. n+�;,:z ��T^-...� .. 's i "�.t ?�a�?'-,
®New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
v ^ .ii, & 0R'r O, TRI OR , .
.. � .� VLY,,.r� : ,:.„r e. � ..w,. w..._.., . ,,J, _, . .. a�,. ,
Valuation: $
❑ I-and 2-family dwelling ®Commercial/industrial
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
' *** FORMATION LOCATION Total number of floors:
Job site address:17480 SW Clementine St New dwelling area: square feet
City/State/ZIP:Beaverton,OR 97007 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:River Terrace North PS Covered porch area: square feet
Cross street/directions to job site:1100'West of SW Roy Rogers Rd., Deck area: square feet
1350'South of SW Scholls Ferry Rd. Other structure area: square feet
)••
f i'iiz MM BF . : -.
•
Subdivision: I Lot no.:1801 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 1S 1 06 equipment,materials,labor,overhead,and the profit for the
- IPTION-OF WORK work indicated on this application.
0 Construction of a new sanitary sewage pump station and 12-inch diameter sewer Valuation: $$219,500.00
force main. Existing building area: square feet
f .\ New building area: 459 square feet
` 0 Number of stories: 1
Name:Mike Kebbe,Clean Water Services Type of construction: VB
Address: 16060 SW 85th Ave Occupancy groups:
N
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(503-)547-8187 Fax:(503)547-8196New: U
, 3 *' .• 'IP CI1N'rACII' PERSON
N°Cib .
Business name:Murray,Smith&Associates,Inc. All contractors and subcontractors are required to be
Contact name:Alex Bargmeyer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 121 SW Salmon,Suite 900 jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97204 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)547-8187 Fax: :(503)547-8196
E-mail:alex.bargmeyer@msa-ep.com
CONTRACTOR
Business name:TertIrcleterentfird Ke„, If'/ / 4 BUILDING PPERMIT S*
Address: 9210 /v� (0y' /41)cG. (Please rc �rtu
e *rs hedgek) , -
i Structural plan review fee(or deposit): 76 3 ii
City/State/ZIP: VA-t3 L., . qg &/P 5
Phone:( 36,033q-- 3/ t. Fax:( ) •
FLS plan review fee(if applicable):
CCB lie.: Jt-/g cf/� Total fees due upon application:
( ( Amount received:
Authorized signature: 1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Alex Bargmeyer Date: 12/30/15 * Fee methodology set by Tri-County Building Industry
Service Board.
I:ABuilding\Permits\SIT-PennitApp.doc 10/01/09 440-4613T(I1/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
11114
T 1 c n k Building Permit Review — Commercial - With Land Use
BuildingPermit
#: Sz�,.2/p16, -a)vvi
Site Address: / ,1Z S'.,.) () P.i:Ane._ . Suite/Bldg#:
Project Name: e/V r-7.-- Ce X/Or A01 __S247, ern_
(Name of commercial business occupying the space. If va ant,enter Spec Space.)
Planning Review
Proposal: IA U ' rIr , Z.i '.� - ' ,. i.;0
dil
•rift'site address/suite# exists and active permit system.
n t'ver Terrace Neighborhood: I o Yes ❑ No
'P ;and Use Case#: Ce/A20,c.- -0_O/
P1anfs Match Approved Land Use:
11G Site Plan Okandscape Plan ❑ Other:
Jrban Forestry Plan eglAevation Plan
/aluilding Height: Maximum Height Actual Height
❑ Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
1 Business Liceenss
Exists: V Yes ❑ No,applicant notified to obtain business license
4ublic Faciliti.es nprovement (PFI) Permit: Zes
Required: V Yes,applicant was notified ❑ No Applied For: ❑ No, stop intake
Notes: `_iil?GX,(77Ung Mies, 4e J _I irmr` A pet712P74- I ,goo?,7c_e___
). /
Approved by Planning: ...._ ,, ,,A_ Date: /0A6/9/,S--
Revisions
00 /,S—Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 604
Site Plans: # 3
Building Plans: # 3
Building Permit#: meter building permit# above.
Workflow Routing: [G-Pla n ngEL _ iineering Lit Coordinator
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: POZ -1-Ge T cAry OVA, r ^ e/ .6r Piuv reLe t i.✓ i Litt S receii."->�
By Permit Technician: Date: OA,
I:\Building\Forms\B1dgPermitRvw_COM_W ithLandUse_070915.docx
Engineering Review
El Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
E l Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
El Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes El No
Assess Water Quantity Fee in-lieu: ❑ Yes El No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes: hi cr.,. s ?tont- TLS 5 ITt. + ?F ( NGtt g -f
Approved by Engineering: ( . ( Date: 2 13/I
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: El Approved El Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
?6 Approved, NOT Released: 40 Date: 2/. /14
Notes: �"jr► /MC owe / �G -eziu,u
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
'SDC Fees Entered: Wash Co Trans Dev Tax: El Yes ` 4.1/A
Tigard Trans SDC: ❑ Yes ,3N/A
Parks SDC: ❑ Yes N/A
rOK to Issue Permit
Approved by Permit Coordinator: a eDate: S
1:A Building\Fonns\BldgPennitRvw_COM_WithLandUse 0709 I 5.docx
1
Albert Shields
From: Albert Shields
Sent: Wednesday, February 03, 2016 5:05 PM
To: 'alex.bargmeyer@msa-ep.com'
Cc: Mike White; Monica Bilodeau
Subject: River Terrace Pump Station, BUP2016-00001 & SIT2016-00001
Attachments: Conditions-02-03-2016.pdf
Alex, at this point none of the Conditions of Approval for the underlying land use case, CUP2015-00001 have been met
so we are putting both of your applications, BUP2016-00001 and SIT2016-00001 on Hold, marked "Approved but Not
Released" until the requisite conditions have been met. I copy of the conditions list is attached. Please let me know if
you have any questions.
Albert Shields
Permit Coordinator
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
17480 SW CLEMENTINE ST, BEAVERTON, OR,
97007
Record Type:
Commercial - Site Work
Inspection Type:
499 Final inspection
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
SIT2016-00001
Inspector:
Chip Barnett
Contractor