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Permit CITY OF TIGARD SITE WORK PERMIT 14 <` Permit#: SIT2016-00015 COMMUNITY DEVELOPMENT Date Issued: 09/22/2016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 BA00300 Jurisdiction: Tigard Site address: Project: Triangle Medical Office Subdivision: None Lot: None Project Description: Grading of site to prepare for future site improvements. Contractor: LEASE CRUTCHER LEWIS Owner: 550 SW 12TH AVENUE PORTLAND, OR 97205 PHONE: 503-223-0500 PHONE: FAX: 503-223-2874 FEES Description Date Amount Specifics: Permit Fee-Site Work 09/22/2016 $1,783.75 Plan Review 09/22/2016 $1,159.44 Type of Use: COM 12%State Surcharge-Building 09/22/2016 $214.05 Class of Work: NEW Info Process/Archiving-Lg$2.00(over 09/22/2016 $14.00 11x17) Project Valuation: $316,820.00 Site Specifics: Excavation Volume: 20170 cu.yd. Fill Volume: 11510 cu.yd. Impervious Surface: sq.ft. Engineered Fill: Soil Report Required: Paving: Grading: Yes Landscaping: Site Prep: Storn Drains: Retaining Wall: Fire Underground: Accessible Parking: Fence: Total $3,171.24 Required Items and Reports(Conditions) 1 Ersn Cntrl 503-639-4175 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. You may obtain a copy of the rules or direct questions to OLINC by calling 503.232.1987 or 1.800.332.2344. Issued By: �I Permittee Signature: ex/ pc.,e!'�% /e2, S, 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. uildi;ig Permit Application Site Work FOR OFFICE LSE ONLY CityNof Tigard Received g ,� DateBy: liFyI, Permit No.: TN `, <61 13125 SW Hall Blvd.,Tigard,OR 9 wit' Plan Review► t Phone: 503.718.2439 Fax: 503.59:.]'i. Date/B lilld �IP Other Permit: T t t h R I) Inspection Line: 503.639.4175 A. VI Date Ready/By: Jun �� ® See Page 2 for Internet: www.tigard-or.gov S �� Notified/Method: Jam;V Supplemental Information tea `' ' a z 8"� _ "w'e "-, y e zz' ' ;ir7', �r n iVArgr„�f;, s������-r'''� �a �":�'��',,��„�, �»�” !r �, �i ,, z...,�� ,a�,� � �w� 4%;' t, t to r 'Q`l l l ❑New construction 1: remolition 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: EARLY GRADING equipment,materials,labor,overhead,and the profit for the t,�, A� a g 8 8 t/s „ � ' t' work indicated on this application. � v... �� ;,:1 ...Sx �,;. ,, ,:: ,' , sem. ,.,c 1-and 2-famil dValuation: $ ❑ ywellin g ®Commercial/industrial ❑Accessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: 4 � Total number of floors:i l r ° ,r I mj k V � `00 i y r ,00,0404400o , Job site address:SW 72ND AVENUE AND SW DARTMOUTH STREET New dwelling area: square feet City/State/ZIP:TIGARD/OREGON/97224 Garage/carport area: square feet Suite/bldg./apt.no.: I Project nameTRIANGLE MEDICAL OFFICE BUILDING Covered porch area: square feet Cross street/directions to job site: Deck area: square feet LOCATED AT THE SW CORNER OF THE INTERSECTION OF Other structure area: square feet SW 72ND AVENUE AND SW DARTMOUTH STREET ` - J:� ii » rAl y "1,', A ifil ,v ;w* prby Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.:TAX MAP 2101 BA/TAX LOT 300 /Q/Q,9da ©Q Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the ';ms's '' . ► ` ` �i' a t '+ -Sink 4 `` work indicated on this application. EARLY GRADING OF THE SITE TO PREPARE FOR FUTURE SITE IMPROVEMENTS Valuation: $316,820.00 Existing building area: square feet New building area: square feet ''Nf tl ` ' i,w Number of stories: Name:BASE CAMP 1,LLC Type of construction: Address:29080 SW PETES MOUNTAIN ROAD Occupancy groups: City/State/ZIP: WEST LINN/OR/99068 Existing: Phone:( 503)880-5623 Fax ( ) '''.44444:211:20 � a' � ,,,,,,„„„,,,,,,,,,,,,,,u,-404,44k. New: a '`' : ,Yei .,„, ,„ ;may , ,' 'Y , 3tt ,,” °Ze t ,, .� tti � ,r -* ' rr1y`arat ;'I ,, .M'„ ,4 er10,4 - -.,40444.44,04*4444, ,, a Vox Business name:BASE CAMP 1,LLC All contractors and subcontractors are required to be Contact name:BRIAN BENNETT licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address:29080 SW PETES MOUNTAIN ROAD jurisdiction in which work is being performed.If the City/State/ZIP: WEST LINN/OR/99068 applicant is exempt from licensing,the following reasons apply: Phone:( 503)880-5623 I Fax::( ) E-mail: BENNETTDEVELOPMENT@GMAIL.COM ,4:50 , ? °o-mr7 ''d al 4 ",' '” ” 4a � x9 s 4. ,x'35,”. "n x va3*sr,..,Y,',..,.I4,4 :.2700 a",�',1,,, , u,,,,,P"°d s,wa r„`,'00,1,�' ,,,.".A',,A,„„k „„AA.�,v,.A„,„.„,„ Business name: LEASE CRUTCHER LEWIS , 9 , . l o IMMr , Address:550 SW 12TH AVENUE �:: =r° 1 t ..,14� b i, <a .. a"; Structural plan review fee(or deposit): City/State/ZIP:PORTLAND/OREGON/97205 Phone:( 503)937-9137 Fax:( ) FLS plan review fee(if applicable): CCB lic.: 92919 Total fees due upon application: 1782.94 Amount received: Authorized signature:c-2This permit application expires if a permit is not obtained [ �► within 180 days after it has been accepted as complete. Print name:i Ci , in A f f Nie. r' Date: y2 �� ..ft * Fee methodology set by Tri-County Building Industry SL b Z, u Service Board. I:ABuilding\Permits\SIT-PermitApp.d c 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: 20,170 cu. yds. Grading Volume: (Soils report required for>5,000 cu. yds.) 31,680 cu. yds. Fill Volume: (Fill exceeding 12"in depth shall be compacted to 90% of maximum density) 11,510 cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU ❑ Concrete ❑ Other: *Total new impervious area including all buildings, sidewalks, and .avin : s•. 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: X❑ Site Plan with Vicinity Map showing ADA ❑ *Parking(including ADA)and Lighting compliance (N/A FOR ADA) Plan N/A X❑ Grading Plan and details ❑ *Landscaping PlanN/A 0 Erosion Control Plan and details ® Soils Report(if required) ❑ Retaining Structures N/A ❑ Fire Line N/A *Does not apply to One-and Two-family dwellings. Plan Submittal: Permit Fee: aleriffiRVIIWAT '" 'r e a' I ' A ' $.00 to$500.00 $51.09 minimum permit fee $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. I:\Building\Permits\SIT-PermitApp.doc 03/08/2016 2 e 1 City of Tigard 1111 q COMMUNITY DEVELOPMENT DEPARTMENT e l l c A R D Building Permit Review — Commercial - No Land Use Building Permit #: 5.1t /4, coo I5 Site Address: Q /0/6,406 0(_.) Suite/Bldg#: Project Name: 7/7aYIcl2 �I•edira l O ce ,..&;4:(4/71 - Ear- � rn gi 69-'104_,,/(Namtdcommercial business occupying the space. If vacant,ente}�ec Space.) / Planning Review (� Proposal: or- ,r," ii 1 #, i�_, • - . '<I /. - ' or- 1Gl//,r� S>k /✓YI 9/_1/'' 'ii Existing Business vActivity: � i s/ Proposed Business Activity: /i Verify site address/suite# exists and active in permit sy,_stt . 1 J 6' 'ver Terrace Neighborhood: ❑ Yes [X No 11oning: c q _)ad/Permitted Use: Yes ❑ No ❑ p Spec Space Lir{{Confirm no land use required. 1/496',31,"i /J. ' 013usiness Licens Exists: ' Yes ❑ No,applicant notified to obtain business license Notes: Approved by Planning: 4 .---- --- 41 Date: %2/// T 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: V&A Site Plans: # Building Plans: # Building Permit#: n r building permit#above. Workflow Routing: fanning CSI ermit Coordinator ding Workflow Sign-off: I Scoff for Planning(include notes from planning review) Route Application Documents: uilding: original permit application, site plans,building plans, engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: l,�t�_,,.t Date: 7/l//, I:\Building\Forms\BldgPermitRvw COM_NoLandUse_070915.docx ( 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: CDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes Pi /A CT Tigard Trans SDC: ❑ Yes ,• /A Parks SDC: ❑ Yes 2 N/A raK to Issue Permit Approved by Permit Coordinator: Date: 9/74 i 4 I:\Building\Fonns\BldgPemiitRvw_COM_NoLandUse_070915.docx