Permit CITY OF TIGARD SITE WORK PERMIT
UPICOMMUNITY DEVELOPMENT
Permit#: SIT2017-00002
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2017
T f r,;a IL i r g Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12160 SW SCHOLLS FERRY RD 100
Project: Bank of America ATM Kiosk Subdivision: None Lot: None
Project Description: Site work for the addition of ATM kiosk
Contractor: ANDERSEN CONSTRUCTION CO Owner: ATLAS GREENWAY LLC
6712 N. CUTTER CIRCLE 333 NW NINTH AVE, STE 1009
PORTLAND, OR 97217 PORTLAND, OR 97209
PHONE: 503-519-5949 PHONE:
FAX: 503-283-4393
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 03/02/2017 $1,047.39
Plan Review 02/07/2017 $680.80
Type of Use: COM 12%State Surcharge-Building 03/02/2017 $125.69
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 03/02/2017 $8.00
11x17)
Project Valuation: $153,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking: Yes
Fence:
Total $1,861.88
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. You may obtain a copy of the rules
or direct questions to OUNC by cal:•• • .1987 or 1.800.332.2344.
Issued By: , Permittee Signature: ,,""�4.c/ -
Call 503.639.4175 by 7:00 a.m.for the next available i .ection date.
This permit card shall be kept in a conspicuous place on the job si, until completion of the project.
Approved plans are required on the job site at the ti e of each inspection.
Uuilding Permit Applic ' .. ,.m ,.F
Site Work d � i i- las F()►Z()FF►('I: I SI:0.\1.1
Received /1��
City of Tigard DatetB /7 Permit No.: fTa? /7 w
, 11413125 SW Hall Blvd.,Tigard,OR i9 E 7 /U /` Plan R ieS
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:/r/iE Z4 17 Other Permit:1-1 1-i pap 1 36
i i G A it 17 Inspection Line: 503.639.417 1. Oft� J Date Ready Juris: ® See Page 2 for
gf� i s
Internet: www.tiS and-or. ov Notified/Method: i;2-A / ,97rSupplemental Information
W 1LFD NGIV,,Ni
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TYPE OF WORK j144 0,411; RE(' DATA:l AND AIGIILY OWELLINO"
❑New construction ❑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
❑Other: equipment,materials,labor,overhead,and the profit for the
CATZGORY'or 614,tf VCT N work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms: _
❑Master builder 0 Other: Number of bathrooms:
.
JOB SITE INFORMATION AND CATION '
`�"" Total number of floors:
Job site address: 12160 SW Scholls Ferry Rd New dwelling area: square feet
City/State/ZIP: Tigard,Or 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: %tk.) Project name: Greenway Shops RATM Covered porch area: square feet
Cross street/directions to job site: SW 121st Ave Deck area: square feet
Other structure area: square feet
REB # DATACOMMERCIAL-USE CHE(KLin
Subdivision: 1 Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Map 1 S 134BC-00200 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.
,..6;1:—.11_,- to074.....„/0? (..A1.5" / % IX Valuation: $ G /.f,2'
Existing building area: square feet
New building area: 75 square feet
Ba PROPERTY OWNER 0 TENANT Number of stories: 1
Name: Atlas Greenway, LLCType of construction: Type III-B
Address: 333 NW 9th Suite 1010 Occupancy groups:
City/State/ZIP: Portland, Or 97209 Existing:
Phone:(503) 709-9918 Fax:( ) New:
Business name: Jones Lang LaSalle All contractors and subcontractors are required to be
Contact name: Debbie Shaw licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 800 5th Avenue, 16th floor jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
Seattle, Wa apply:
Phone:(41 5) 407-1074 Fax: :( )
E-mail:
CONTRACTOR Business name: Andersen Construction BUILDING PERMIT FEES*
Address: 6712 N Cutter Cir fP�"r rete to leg" `�
y Portland Oregon 97217 Structural plan review fee(or deposit):
City/State/ZIP:
—
FLS plan review fee(if applicable):
Phone:(503) 283-6712 Fax:( )
CCB lic.: 0,1:1„1.54"711:1C.-',0 5_3 Total fees due upon application:
Amount received:
Authorized signature: ,•011=0,0 This permit application expires if a permit is not obtained
7 within 180 days after it has been accepted as complete.
Print name:: �f�. ,401::,,, ..g,...- Date: Z /O/2 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(11/02/COM/WEB)
s
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
III
T 1 c A R o Building Permit Review — Commercial - With Land Use
Building Permit #: c 1 -p/? - C560 O 2-
Site Address: d L „„ . Aouite/Bldg#:
Project Name: fiI 64 rZt'�i"�
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review ,�/
Proposal: Aj1tt> /777 ,vU L oz.,tCL iYle,I/7 ...pots' '/L Lt, /e..4,yg
IJa Verify site address/suite#exists and active in permit sY ste .
fjd ver Terrace Neighborhood: ❑ Yes No
/and Use Case#:6. MnhJ QO/( 6,00
ad Plans atch Approved Land Use:
Site Plan t. andscape Plan Ether:
11,rban Forestry Plan 1014Vlevation Plan
(0) t.;uilding Height: Maximum Height Actual Height
ICI k onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
!I Business Lice e:
Exists: Yes ❑ No,applicant notified to obtain business license
1,C. ff ublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: c_..-----------,—._,—_ Date: o�
Revisions (after Building Submittal only) Reviewer Date
- --- R cviatm I. 0 Approved - ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 2/7/7
Site Plans: # 3
Building Plans: # '3
Building Permit#: [-Enter building permit#above.
Workflow Routing: ErPlanning C-Engineering ❑,Perinit Coordinator wilding
Workflow Sign-off: Er-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:
By Permit Technician: r Date: ,,9-/7X-7
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Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of b • i• g permit
❑ Easements (encroachments)per engin:-ring conditions of approval and plat(not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in deu: ❑ Yes ❑ No
Assess Water Quantity F,• in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved Engineering: Date
Notes:
Approved by Engineering: di_, Date: __, -/,4147
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
O 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:
DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes 4N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
OK to Issue Permit
C
Approved by Permit Coordinator: Date: "27, 1l7----
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