Permit (29) CITY OF TIGARD SITE WORK PERMIT
111
' COMMUNITY DEVELOPMENT Permit#: SIT2016-00004
Date Issued: 06/02/2016
Tt 'AIz 13125SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 25110AA00900
Jurisdiction: Tigard
Site address: 14050 SW PACIFIC HWY
Project: ESP Property Factors, Inc. Subdivision: KING CITY TERRACE CONDO Lot: 3-6
Project Description: Reconstruction of(2)ADA parking stalls and ADA accessible route. Removal of(3)standard parking stalls.
Contractor: PIHL INC Owner: ELLINGSON REVOCABLE INTERVIVOS T
41660 NW SUNSET HWY BY ELLINGSON,JOSEPH M &JEAN E TRS
BANKS, OR 97106 420 W LASSEN AVE
CHICO, CA 95973
PHONE: 503-324-6210 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 06/02/2016 $626.50
Plan Review 03/03/2016 $407.23
Type of Use: COM 12%State Surcharge-Building 03/03/2016 $75.18
Class of Work: ALT Erosion Control w/Development 06/02/2016 $161.40
Project Valuation: Info Process/Archiving-Lg$2.00(over 06/02/2016 $14.00
$65,333.00 11x17)
Site Specifics:
Excavation Volume: 22 cu.yd.
Fill Volume: 34 cu.yd.
Impervious Surface: 308 sq.ft.
Engineered Fill: Soil Report Required:
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: No Accessible Parking: Yes
Fence:
Total $1,284.31
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State . 44Jk. Spec':Ity Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expir if 'rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires y• to •pow the r es adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-W-001
You ma obtain a copy of the rules
or direct que ns to 0 b C • - ling 503.232.1987 or 1.800.332.2344.
Issued y: / Permittee Signature: 41111k_
Call 503.639.4175 by 7:00 a.m.for the next available inspe r on date.
This permit card shall be kept in a conspicuous place on the job site unt completion •f the project.
Approved plans are required on the job site at the time of each inspection.
fl o
puildin2 Permit Application
Sitek;Urk FOIL O I l i t I t a t O v I 1
City of Tigard \\41e9
Received 16 Permit No.:
cicyy
114 1* 13125 SW Hall Blvd.,Tigard,OR ' Plan Re `►1 �� �t' 6
e; - Other Permit:
Phone: 503.718.2439 Fax: .;, DateBy: f►1MQ a� s— ocx�33
i Inspection Line: 503.639.417 .'' 3 'Lp16 Date Ready : : c i G j/ loris: ® See Page 2 for
y t c ,\k Il Internet: www.tigard-or.gov Notified/Method: 70 da Supplemental Information
TYPE O �1o,V��Z�N REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction �� i'‘ alit on 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.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:14050 PACIFIC HIGHWAY New dwelling area: square feet
City/State/ZIP:TIGARD,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: :.SP ��e i14&p ,, cf Covered porch area: square feet
Cross street/directions to job site: r""`���� Deck area: square feet
The project is located at 14050 SW Pacific Highway;south of SW McDonald Street, Other structure area: square feet
and east of SW Pacific Highway REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: WCTM 2S110AA,900 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.
Reconstruction of two ADA parking stalls and ADA accessible route and removal of Valuation: $65333.00
three standard parking stalls.Stall and route constructed to current accessible Existing building area: 12520 square feet
standards.Improvements to 99W reduced parking lot maneuvering area. New building area: 0 square feet
® PROPERTY OWNER 0 TENANT Number of stories: 2
Name:Ellingson Revocable Intervivos Trust Type of construction:
Address:22018 S.Central Point Road Occupancy groups:
City/State/ZIP:Canby,OR 97013 Existing: 12
Phone:(503)245-1177 Fax:( ) New:
0 APPLICANT ® CONTACT PERSON NOTICE
Business name:CESNW,INC All contractors and subcontractors are required to be
Contact name:John Jensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:13190 SW 68.Pkwy,Suite 150 jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)968-6655 Fax::( )
E-mail:jjensen@cesnw.com
CONTRACTOR
Business name:Pihl Excavating BUILDING PERMIT FEES*
Address:41660 NW Sunset Hwy
(Please refer to fee schema)
Structural plan review fee(or deposit): $622.91
City/State/ZIP:Banks,OR 97106
Phone:(503)324-6210 Fax:(503)324-1017 FLS plan review fee(if applicable):
Total fees due upon application: $622.91
CB lic.:121460
v, 3/A—rii1i
� Amount received:
Mori ed si atu This permit application expires if a permit is not obtained
i .
within 180 days after it has been accepted as comnlerP
rte: (i,c f, A^ -54//
Date: G * Fee methodology set by Tri-County Building Indus
V Service Board.
Permits\SIT-PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
•
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: 22 cu. yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 35 cu. yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 34 cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks,and paving: 308 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-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
1:\Building\Permits\SlT-PermitApp.doc 05/25/2012 2
R w
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
ill 111s
T 1 lz Building Permit Review — Commercial - With Land Use
Building Permit #: 57'-7-go i to 0000E i
Site Address: tL1oSO `J Pact-ci(_, kv 11 , Suite/Bldg#:
Project Name: tSp pro 6c.-tpl,s
(Name of commercial bins occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: drAny G +0 Qay-kl yl c rd landscape n)
N(Verify site address/suite# exists and active in permit system.
\noRiver Terrace Neighborhood: ❑ Yes No
1k Land Use Case #: Kg1020I6—0 3.2)
m Plan/Match Approved Land Use:
Site Plan M Landscape Plan ❑ Other:
—E—Urban Forestry Plan $'Elevation Plan
i :uilding Height: imum Height - tual Height
n Conditions Met: MA Prior to Submittal ❑ Prior to Permit Iss ante
-E"Business License:
Muth- `1 1 7 "tof 4rg� remO'J ) laeff
Exists: ❑ Yes ❑ No, applicant notified to obtain business license
XPublic Facilities Improvement (PFI) Permit:
Required: ❑ Yes, applicant was notified ' No �1 +r'Applied For: ❑ Yes ❑ No, stop intake
Notes: o fo'v& �`o( 1 a. • — rnt St copy\ / tot ee, reV11 V& ��►'mrf' 1)11;Of -}p 1 SS(Ae
JJ
Approved by Planning: la rba cn Date: 3 3 I b
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 J
Original Submittal Date: 3/ ./6
Site Plans: #
Building Plans: #�
Building Permit#: ntnt r building permit above.
Workflow Routing: Lt'P]a sing IrJ�Engineering C�-1�lsermit Coordinator C�—Building
Workflow Sign-off: LZI'Si 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: -_ - i ate: 3. ,4/4/
A
L\Building\Fonns\BldgPennitRvw_COM_WithLandUse_O709I 5.docx
ngineering Review
Slope at building pad:
PFI Permit#:
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: E Yes No
Assess Water Quantity Fee in-lieu: ❑ Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date
Notes:
ieL . )
Approved by Engineering: 2Date: iT,
— --�
Revisions (after Building Submittal only) Reviewer f Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
Approved,NOT Released: Date: 3 AP/i(
Notes: ,i! 4444 f — v\ g..-kS 41-ek. r-e rti,UV4 re.7"eN- : �,
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: ❑ Yes E 4 /A
Tigard Trans SDC: ❑ Yes ►nom /A
Parks SDC: ❑ Yes VA N/A
C OK to Issue Permit
Approved by Permit Coordinator: a,`""'z'_" ,t
Cqvw� Date: S - `j - 1 Co
1 TriT42..,ry r.: 010 p rt►Vt d 4 TRE a o f a -000 1 0
I:`Building\Fonns\BldgPermitRvw_COM_W ithlandUse_0709I 5.docx
FOR OFFICE USE ONLY—SITE ADDRESS:
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
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: r, 1V� �,` DAT
Pitrttit
DEPT: BUILDING DIVISION tD
MAR 2 8 2016
FROM: ✓��r,—� CITY OF TIGARD
BUILDING DIVISION
COMPANY: CiGS\AO �1 c
X
22
PHONE: 3—c-3 � �o� rBy.
RE: ��i� PPt e‘ 6 c_ 14-Loy c I i I — C �
(Site Address) (Permit Number)
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Additional set(s)of plans. 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: . C0,47\) ‘,-,ed � c✓lis
Routed to Permit Technician: Date: (( IMIEELTI%r AM
Fees Due: • Yes DFo Fee Descri s tion: Amount I ue:
Special
Instructions:
Re I rint Permit •er PE : • Yes ■ No ■ Done
A. •licant Notified: Date: Initials:
I:\Building\Forms\TransmittalLetter-Revisions.doe 05/25/2012