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Permit CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Permit#: SIT2016-00002 I f G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/17/2016 Parcel: 1 S126CD00100 Jurisdiction: Tigard Site address: 9925 SW GREENBURG RD Project: Crescent Grove Cemetery Expansion Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: Construction of a drive aisle,private storm drainage and water line extension. Contractor: BRIAN CLOPTON EXCAVATION INC Owner: CRESCENT GROVE CEMETERY ASS P 0 BOX 509 CRESCENT GROVE CEMETERY WILSONVILLE, OR 97070 9925 SW GREENBURG ROAD TIGARD, OR 97223 PHONE: 503-682-0420 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 05/17/2016 $3,323.82 Plan Review 01/14/2016 $2,160.48 Type of Use: COM 12%State Surcharge-Building 05/17/2016 $398.86 Class of Work: ALT Info Process/Archiving-Lg$2.00(over 05/17/2016 $48.00 11x17) Project Valuation: $660,000.00 Erosion Control w/Development 05/17/2016 $611.40 Site Specifics: Excavation Volume: 1532 cu.yd. Fill Volume: cu.yd. Impervious Surface: 27624 sq.ft. Engineered Fill: Soil Report Required: No Paving: Yes Grading: Yes Landscaping: Yes Site Prep: Yes Storn Drains: Retaining Wall: No Fire Underground: No Accessible Parking: No Fence: No Total $6,542.56 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 - icatio enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or dir: t questions to calling 503.232.1987 or 1.800.332.2344. Issued By: / ik/ , Permittee Signature: a(Jd ia-0),,) 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 Work14t1C1 FOR 01 I I( I: t ,1:ONI.I 111 City of Tigard Date Received t. , /lp , Permit No.:.7.i- -...t 13125 SW Hall Blvd.,Tigard,OR 97 r1-%\C° man R XYX`r� Phone: 503.718.2439 Fax: 503.598.1 �O `� Date t At-.4i (tiOther Permit:ryvy)Q 0rrl:at� 6 t 1 c ;\I;D Inspection Line: 503.639.4175 P' `. 1R,V to Ready : �y�. luris: ® See Page 2 for Internet: www.tigard-or.gov , , p sal c11� tified/Meth.; J 7 14 j3 J o Supplemental Information .-0eitii{ ,e C, F\\i �i? 441\4\s`... �.. `\ ,., %� `Nio,a,%e ; ,t'•,„t1y `3;a [” ,,a) ` .u# Permit fees*are based on the value of the work performed. ®New construction ❑De Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the '-,',041,04,1ZAV' ttkY � gwork indicated on this application. Valuation: $ ❑ 1-and 2-family dwelling Commercial/industrial ElAccessory building 0 Multi-family Number of bedrooms: 0 Master builder ®Other: Number of bathrooms: F: -, r t Total number of floors: Job site address:9925 SW Greenburg Road New dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet -70 uite/bldg./apt.no.: Project name:Crescent Grove Cemetery Covered porch area: square feet Cross street/directions to job site: i'ry Deck area: square feet '. J t ! ,V5 ,,�1 ._r i5 •,-E Other structure area: square feet Subdivision: ,p, r.0 Lot no.: a 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.: 1S1W26CD tax lot 100 'v- i equipment,materials,labor,overhead,and the profit for the �, 3it 1' '''::';''''''':17" i (i ��� work indicated on this application. 00,000i00000 ; Valuation: $$660.000.00 new drive aisle,drainage improvements,water service improvements Existing building area: square feet New building area: square feet 00.* 0 4+§ + .t + 4!,,,4:4-Verta���o����, 4:3 ; Number of stories: Name:Crescent Grove Cemetery Type of construction: Address:9925 SW Greenburg Road Occupancy groups: P City/State/ZIP:Tigard,OR 97223 Existing: i Phone:(503)639-5347 Fax:(503)620-1264 New: 4 Business name:Crescent Grove Cemetery All contractors and subcontractors are required to be Contact name:Nancy Felton licensed with the Oregon Construction Contractors Board - under ORS 701 and may be required to be licensed in the Address:9225 SW Greenburg Road jurisdiction in which work is being performed.If the City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons apply: Al, Phone:(503)639-5347 I Fax::(503)620-1264 Viet E-mail:nancy@crescentgrovecemetery.com *'N'a , \ c,,V : CONTRACTOR Business name: —624 to a t P772 k) Eye4u,t r X10 o ` ��`-�?k Address: PD .(2-DL x, 6-0 - p 1 G� v Structural plan review fee(or deposit): City/State/ZIP: lJ „'5522) �2) (0 © Fax:( )q70767 FLS plan review fee(if applicable): Phone:(55 J l{UUlJJJ_ CCB lie.: G5�,, '' 7 Total fees due upon application: Amount received: Authorized signature: Ct,l�l C-� gai__,f This permit application expires if a permit within 180 days after it has been accepter Print name: al� C1 ' L L. Fe i Date: I V . \V * Fee methodology set by Tri-County Buildin; `j t Service Board. I:\Building\Permits\SIT-PermitApp.doc 10/01/09 440-4613T(I1/02/COM/WEB) City of Tigard: Page 2 - Supplemental InformationSiteWorkPermit Checklist 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: 1532 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: 27624 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: Tyro**,SUBMITTAL #of Plans >r + ;. N`ew,Additionsor, Required.at $.00 to$500.00 $51.09 minimum permit fee Atte' " 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-1 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. ilding\Permits\SIT-PermitApp.doc 05/25/2012 2 1 + . 1 City of Tigard IIIr COMMUNITY DEVELOPMENT DEPARTMENT ■ T G n Building Permit Review — Commercial - With Land Use Building Permit #: j a0/1 _axy- Site Address: I?015 tA) 4-G t-03 /,d, Suite/Bldg#: Project Name: C�Sr - Grove-- 6-tyle---le-e- - (Name of commercial business occupying the space. IVvacant,enter Spec Space.) Planning Review Proposal: Verify site address/suite#exists and active in permit system. *River Terrace Neighborhood: ❑ Yes .No NJ Land Use Case #: MMCD 201 S- =26 JE Plans Match Approved Land Use: .T7 Site Plan ❑ Landscape Plan ❑ Other: ❑ Urban Forestry Plan ❑ Elevation Plan G` Building Height: Maximum Height Actual Height J2"-- onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance Business License: Exists: -4a-Yes ❑ No, applicant notified to obtain business license ti 0-Public Facilities Improvement (PFI) Permit: Required: 'Yes, applicant was notified ❑ No Applied For: ❑ Yes ❑ No,stop intake Notes: L i-\n() U3-e. C'e�-tc LL! it4„4. �}1v 5 i14 - J ' r�-ppfot. (ew-. / VS Ione 11 tall�.�C"o,,s .,#.41./6, 0„),, Approved by Planning: 6 r V Vii/( LMte: I --/c/61 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: I/7// Site Plans: # a rrc e ,,r,,, at 1 , 5c"f ,W, Building Plans: # ,� tt " > i, Building Permit#: IE nter building permit# above. Workflow Routing: armingngineering ermit Coordinator El Building Workflow Sign-off: ❑ Sig . ff 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: By Permit Technician: __ -01IIIP : .te: i Alr/„ 1:\Building\Fonns\BldgPennitRvw COM WithLandUse 0709I5.docx Engineering Review ❑ Slope at building pad: QrPFI Permit#: rfnDIO-00005- ❑ Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP) ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes E No Assess Water Quantity Fee in-lieu: E Yes ❑ No LIDA Facility on lot: ❑ Yes ❑ No gl NOT Approved by Engineering: /au idg ."9 Date /A 0,6 Notes: O .A d , ' a .. _ J. A '0 .. ii / _a: i (ih J r f /flYf f, Approved Gy Engineering: Date: Revisions (after Buil ing Submittal only) Review-r Date Revision 1: L Approved ❑ Not Approved i 51/2/1; Revision 2: ❑ Approved E Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: Date: Notes: Revisions (after Building Submittal only) , l Revision Notice 1: Date Sent to Applicant: / // c Revision Notice 2: Date Sent to Applicant: / ��.:P� LJ Revision Notice 3: Date Sent to Applicant: DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A Tigard Trans SDC: ❑ Yes :. N/A Parks SDC: ❑ Yes r N/A rOK to Issue Permit Approved by Permit Coordinator: eiki4..) hJ Date: 5# (a —1 I:\Building\Forms\BldgPennitRvw_COM_With LandUse_0709I 5.docx FOR OFFICE USE ONLY—SITE ADDRESS: 9 •c7 --5 S& Q U/2--G This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Transmittal Letter LIS V' I 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov TO: DAMMED DEPT: BUILDING DIVISION MAY 12 7016 FROM: *OSP ,Ir l-,e (k. Branna r CITY OV flG RD COMPANY: (-fl' (Z BUILDING DIVT it)N PHONE: 5 03 a a I -(( 3 I :41► •RE: 9955 Si �are.ev�bu"c S/T-Q° /� -- 0000 D, 1 (Site Address) (Permit Number) CA'eJCe n 1 Cart,re- Cle e -te (Project name or subdivision name and lot number)0 ATTACHED ARE THE FOLLOWING ITEMS: Additional set(s) of plans. 3 Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): REMARKS: S-I-Dr N, tti ed-e✓ cl•e-i-e.` o n re tr. .-t--d bi r-1 n e e ,-1 -1>e c- Rai IA)o I f-F. Pe(i,s--e d p/o,.,s n u ) rn a-Jc, i cipp.-v v ed Pf= T p1avi.s. Routed to Permit Technician: _ Date: ''7 g-zg_jk 1 Fees Due: • Yes Ell" o Fee Descri.tion: Amount 1 ue: $ $ $ $ Special Instructions: Re.rint Permit 'er PE : ❑ Yes El No ❑ Done A A. •licant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012