Permit (106) CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2017-00025
Tf AT r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2017
Parcel: 2S1136000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: TPS Building: Site work permit for an interior remodel and 520 sq.ft.addition which does not extend beyond
current overhang.
Contractor: TS GRAY CONSTRUCTION Owner: CLEAN WATER SERVICES
12705 SW HERMAN RD 2550 SW HILLSBORO HWY
TUALATIN, OR 97062 HILLSBORO, OR 97123
PHONE: 503-692-4675 PHONE:
FAX: 503-692-9292
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 09/25/2017 $252.84
Plan Review 09/20/2017 $164.35
Type of Use: COM 12%State Surcharge-Building 09/25/2017 $30.34
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 09/25/2017 $6.00
11x17)
Project Valuation:
$17,000.00 Erosion Control w/Development 09/25/2017 $80.70
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 520 sq.ft.
Engineered Fill: Soil Report Required:
Paving: Grading:
Landscaping: Site Prep:
Storn Drains: Retaining Wall:
Fire Underground: Accessible Parking:
Fence:
Total $534.23
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•u y o a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: it 2'L
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.
Ar4. -* 'f' l7.- ' *- -
Building Permit Application RFCFiVfl�}"
Site Work FOR OFFICE USE ONE\'
SEP 2 2 6 1 Received 9 %�/7 V Permit No.;�/� /7.-0( 2
City of Tigard Date/By
1. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan R Y �� Other Perini uF /7 Ql ee
Phone: 503.718.2439 Fax: 503.598.190 "" Of 'I >;1 8 x. Date/By Juris: ® See Page 2 for
Inspection Line: 503.639.4175 Date Ready :y: / /�
T 1 G A R D Internet www.tigard-or.gov
* •, F DI .ified Method: G Supplemental Information
TYPE OF WORK REQUIRED DATA:1 AND 2-FAMILY DWELLING
0 Demolition Permit fees*are based on the value of the work performed.
❑New constructionIndicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION
Valuation: $
❑ 1-and 2-family dwelling Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
Number of bathrooms:
❑Master builder 0 Other:
JOB SITE INFORMATION AND.LOCATION Total number of floors:
New dwelling area: square feet
Job site address: 1 4O6 0 Et"' AV
�it Ci-na, Garage/carport area: square feet
City/State/ZIP: "V�,(. RA)
Suite/bldg./apt.no.: Project name:
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
gi'Lito 4P. VU go Rik 1M Other structure area: square feet
tEQITIRED D iT,A«COMMERCIAL-USE CREFK:LIS'
Subdivision: I Lot no.: 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: equipment,materials,labor,overhead,and the profit for the
DESCRIP'T'ION OF WORK f` ' * ' work indicated on this application.
Valuation: g 0.0_,asi,-
DavhdD st. eYVI T..f4 Co It Ler-U0'44 CI} 44 6w' Existing building area: square feet
SP(JsGhltC6 6R. L'GN 6 ASA D slopi% f�ucGw'rr4ts
New building area: square feet
# Number of stories:
Name: C/W W{ 6Ri S-61LA U. iS Type of construction:
Address: ti(0O6C) S'V.! Itsv.1 Ave Occupancy groups:
City/State/ZIP:"'(''(o(optch C30R., ..1'L1,,y Existing:
Phone: ) + I g` Fax:( ) New:
' � t, „% *g. 4-ems )
Business name: it ciD•14ty Cj:71.4 j"zAA,cr— .C>t4 All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: piT Wl'GC.k-f P.,„b under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
�0 Q t‘,0c, applicant is exempt from licensing,the following reasons
City/State/ZIP: S�H�t (7 I p pv. q}14 0 apply:
Phone:(503)ft Zr 4(®}s I Fax::( )
E-mail: dil vvi t C►YIGIi i 1'a .Yr,.FtY'4 L.tt oh.G•o
mrTo
co7,,
Business name: 'cc c (Liay C,ON,S`ra-uc• 447>x sIVBUILDING PERMITTEE *
q x (Please`efer to fee schedule)
. v 0' ..
Address: Structural plan review fee(or deposit): /6,y,, 5_5'
City/State/ZIP: FLS plan review fee(if applicable):
Phone:( ) I Fax:( ) Total fees due upon application:
CCB lic.: t Ct5rtS i Amount received: f�, as-
Authorized signature: �� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: r vvZ(„`114� p I Date: 1/V t/13 I * Fee methodology set by Tri-County Building Industry
u // Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 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: 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: cj O 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
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OFSUBMITTAL . Ater Pious 7
(New,Additions or Required at $.00 to$500.00
� $51.09 minimum pemut fee
Alterations) } Suimlttal� $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 foreach additional$1,000 or
fraction thereof,to and including
One-&TwoFamily Dwelling 3 $25,000.00,
$25,000.01 to$50,000.00 $338.92 for the first$25,000.00 and
$8.06 for each additional$1,000.60 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\Pernlits\SIT-PennitApp.doc 08/02/2016 2
4.5t.>k y60 i
City of Tigard
14 n I', COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial No Land Use
TIGARD
0 r,.,d<i r^4aa.,' ,,, ,,,t v '.,_,,‘::;34,,. : .,4.t`'ara,.a.:a, t-` +.,a. .,*;a z AVveY-W tr44,4 -,� a i,€rt.,—ETZaz. .Z,=;,r,,,1-7 x r5s:.J
Building Permit #: S'/%: f 7 `i 5
Site Address: I G(9 6 0 S W 'B S WI 01 v'2- Suite/Bldg#:
Project Name: GWS TPS evItolivtid at.'voo
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review /�
Proposal: CCN -1.--pg- (3 vii dA (ZeAeNn 0 L'
44
cw c 4. asv,iofAvz
Existing Business Activity: CAW;
Proposed Business Activity: C t/ S
6 Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: 0 Yes ❑ No
AyZoning: I Permitted Use: ,0 Yes ❑ No ❑ Spec Space
Confirm no land use required.
❑ Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes: No tc4nd ud-Q 1"'n 1'3' 6S0 . 080. C
Approved by Planning: Al,04."^ Date: q/ 24 / l 1
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: ❑ Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: 9,0,E 7
Site Plans: # ,3
Building Plans: # 3
Building Permit#: 2 Enter building permit#above. z
�:J� ��
�
Workflow Routing: Planning 0""Permit Coordinator rBuilding .0 6i
Workflow Sign-off: ESign-off for Planning(include notes from planning review)
Route Application Documents: [L}-wilding. original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: , .�'' Date: 9/20 2
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_060116.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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
K to Issue Permit
Approved by Permit Coordinator: Date: g/).42'c
1
Engineering Review
❑,l'ope at building pad: Ai/A-
LfLonditions "Met"prior to issuance of building permit
asements (encroachments)per engineering con tions of approval and plat
Water Quality/Quantity Facility: L /1,60,
Assess Water Quality Fee in-lieu: 0 Yes No
Assess Water Quantity Fee in-lieu: 0 Yes No
LIDA Facility on lot: ❑ Yes No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: ���%
Date: Q�.20/4-
Revisions (after Building Submittal y)
Revision 1: 0 Approved 0 Not Approved Reviewer Date
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved ❑ Not Approved
I:\Building\Forms\BldgPemutRvw_COM_NoLandUse 070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16060 SW 85TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Site Work SIT2017-00025
Inspection Type: Inspector:
499 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor