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Permit (51) CITY OF TIGARD SITE WORK PERMIT COMMUNITY DEVELOPMENT Perm it#: SIT2016-00010 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2016 T[C �1TT,T 9 Parcel: 1 S 136CC00100 Jurisdiction: Tigard Site address: 8200 SW PFAFFLE ST Project: Westside Christian High School Subdivision: None Lot: None Project Description: Remove and replace existing pavement and base rock.Like for like,no change in configuration or ADA stalls. Contractor: GREGORY PACIFIC CORP Owner: WESTSIDE CHRISTIAN HIGH SCHOOL I 11650 SW 67TH AVE#130 BY DAVIS, DANIEL A, PRESIDENT PORTLAND, OR 97223 8200 SW PFAFFLE ST TIGARD, OR 97223 PHONE: 503-639-3887 PHONE: 503-697-4711 FAX: FEES Description Date Amount Specifics: Permit Fee-Site Work 08/09/2016 $1,577.21 Plan Review 07/21/2016 $1,025.19 Type of Use: COM 12%State Surcharge-Building 08/09/2016 $189.27 Class of Work: ALT Info Process/Archiving-Sm$0.50(up to 08/09/2016 $3.00 11x17) Project Valuation: $271,000.00 Erosion Control w/Development 08/09/2016 $311.40 Site Specifics: Excavation Volume: 0 cu.yd. Fill Volume: 0 cu.yd. Impervious Surface: 0 sq.ft. Engineered Fill: No Soil Report Required: No Paving: Yes Grading: No Landscaping: Yes Site Prep: Yes Storn Drains: Retaining Wall: No Fire Underground: No Accessible Parking: Yes Fence: No Total $3,106.07 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 952-001-0090. Y. obtain a copy of the rules or direct questions to OUNC by calling 503.232. 800.332.2344. / �1% Issued By: /). 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. 1 '• i BuIding Permit Application Site Work FA* 4 FOR OFFICE USE ONLY City of Tigard Received III 11 13125 SW Hall Blvd.,Tigard,OR 97223 I q Date/B : 1, f< A� 4 Permit No.: e.�e.r lb g j U_. 2 1 2 0 16 Plan Review t ',,� p/4 Phone: 503.718.2439 Fax: 503 598.1960 Date/B : ".".- ;`�'f � Other Permit: T 1('A R D Inspection Line: 503.639.4175 ()Fry (* Date Read /B Juris: r 4 g 1 # Ready/By: ® See Page 2 for Internet: www.tigard-or.gov s j S t h A Notified/Method: , /G '1a Supplemental Information .711 ni � 2 T1 t !rjo r__ -- r. F TYPE•OF"WORT{ .. #:. >IIR)lIbDATA 1< ANU2-FAMILY"DWELLIiG ❑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 X Other: equipment,mterials,labor,overhead,and the profit for the ' 0'`4 ` CATS OR OF 14iTRU 'TIO i r : work indicated on this application. ❑ 1-and 2-family dwelling ,®Commercial/industrial Valuation: $ ElAccessory building ❑Multi-family Number of bedrooms: El Master builder c]Other: Number of bathrooms: dOB STTE.INFORMATION`ANA LOCATIO Total number of floors: Job site address: g 2 00 tom, ? a Lk q J f tT New dwelling area: square feet City/State/ZIP: r+-cs as-A r a \Zs 1 '712 -.5 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: Pear IC.tti,9 LA- IAGth`k'i1G.,c a Covered porch area: square feet Cross street/directions to job site: O ? r .,t S e c S k- E i' Ti/NC Deck area: square feet 1 n Srers e.c 6rN 0 S. Six-) I.-I 4-11 j)v t:A. ckr1a Other structure area: square feet CIA ( SV. REQI71RETI DATA:;CoMMFRCIAL-VSE CHECKLIST Subdivision: 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 t x.. equipment,materials,labor,overhead,and the profit for the '; ',DESCRIPTION-OP WORK work indicated on this application. Rer,oVe Cr ç -e.Ki-s i1,1 Pkget•..n ckv,o, b,se Valuation: $ a 7�� ood . 0 7 Y Lie I< kr� T.e..pt ace m.e rN`.- L_l k g... Fe2 1-1 Kg Existing building area: square feet New building area: square feet h' _'. PROPERTY OWER .:. . x 0 TEANT Number of stories: Name: LA.)eS4 5tc\e Cl-,r1S "tares ,C� }-� 1., SChac)1 Type of construction: Address: $Z 00 S(.-) P. c h a' f{t S Occupancy p y groups: City/State/ZIP: Ta. l ar 1 d v, 9 7 ZZ 3 Existing: Phone:(50'3 ) 4 q 7- (-I"lit Fax:( ) New: ,. 0"APPLICANT `. ' Q CONTACT,PERSON Business name: pi•e%r rads nCj 1 r,ee r'i,5 a.,a Ize Sour cc,S All contractors and subcontractors are required to be Contact name: K1 e t \ P 0..=L k licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: I\7 31 tj 6.3 L,;z d lar.► (Z e, jurisdiction in which work is being performed.If the City/State/ZIP: ?or )ah A ©k q-7 2.2 applicant is exempt from licensing,the following reasons Phone:(5D"5) 7 ci)- -59 (¢C1 l Fax::( ) apply: E-mail: r\e i I € per - L'r con. , C NT'ItACTOR ,. r. Y•, Business name: �1k€ (-:) r pa c t'ft C Corp BIj 1r,:D NG ERMIT'FEES* Address: I I (OS O c;GJ (S1-7 AVC' y 3fr(Plen,e,r, tw sck d±de� City/State/ZIP: '7 Structural plan review fee(or deposit): far1a�d ) C o 1722.3 Phone:(SO`�j)Ca 39 _ 3 bb 7 Fax:(S)'3)(.Q (j.. (06(00 FLS plan review fee(if applicable): CCB lic.: 1 Total fees due upon application: Authorized signature:Aed �� Amount received: d! btS. qThis permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: IQ e.t 1 7i ekrok- Date: ! / 1 f��of * Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\SIT-PennitApp.doc 10/01/09 440-4613T(11/02/COM/WEB) I It 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.) 0 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: 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 aluation: •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 3 $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:ABuilding\Permits\SIT-PennitApp.doc 03/08/2016 2 A ti City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TICARD Building Permit Review — Commercial - No Land Use Building Permit #: a i i o9-v 1(a -000 (d Site Address: 2OO Ste/ f+ Suite/Bldg#: Project Name: WiS-} . s PA r - (Name of commercial business occupying the space. If vacant,ei(er Spec Space.) Planning Review Proposal: 1('epAVt pG1, V105 �0t Y(S'�►plY) �O QXIs"�1V�v1 C �tfi ---s —Vl O Cl( Existing Business Activity: 4-1 L \ RAT Proposed Business Activity: 'c( AVln(j Verify site address/suite#exists and active in permit system. kRiver Terrace Neighborhood: ❑ Yes .1Rt No , Zoning: 1\/1, Permitted Use: Yes ❑ No ❑ Spec Space _ S cu P ,z Confirm no land use required. ,Sr Business License: Exists: ❑ Yes CINo,applicant notified to obtain business license Notes: No Ci 1(/1 Yl t pA r V-� \ �• Approved by Planning: Ai j o/J, 4- Date: 7, 2(. ICP Revisions (after Building Submittal only) Reviewer Date Revision 1: El Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: 1/94 1 i Site Plans: # Building Plans: # 3 Building Permit#: a Enter building permit#above. Workflow Routing: D's Planning CJ Permit Coordinator 1=14uilding Workflow Sign-off: [fi Sign-off for Planning(include notes from planning review) Route Application Documents: Er Building: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: CK____)acia_44,LiaL) Date: 74/jib I:\Building\Forms\B1dgPermitRvw COM NoLandUse 060116.docx J •► Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: 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 Ms /A Tigard Trans SDC: ❑ Yes '!-N/A Parks SDC: ❑ Yes 7 N/A K to Issue Permit / Approved by Permit Coordinator: I Date: 2/ ` I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx