Permit (64) CITY OF TIGARD SITE WORK PERMIT
IIII3
' . COMMUNITY DEVELOPMENT Permit#: SIT2017-00034
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 12/13/2017
TIGARD
9 Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 9230 SW BURNHAM ST
Project: Tigard Taphouse Subdivision: None Lot: None
Project Description: Erosion control only:4500 sq.ft.of grading work per clean water services.
Contractor: TENANT Owner: DOLAN &CO LLC `
MIKE MILLER BY FLORENCE T DOLAN
TIGARD TAP HOUSE 4523 NE DAVIS ST
9230 SW BURNHAM ST PORTLAND, OR 97213
TIGARD, OR 97223
PHONE: 650-422-0572 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Erosion Control Only 12/13/2017 $322.80
Info Process/Archiving-Lg$2.00(over 12/13/2017 $2.00
Type of Use: COM 11x17)
Class of Work: ALT
Project Valuation: $0.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: 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 $324.80
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 the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 9 1-!.'0. ou may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.198 2.2344.
Issued By: f 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.
r Building Permit Application
Site Work FOR OFFICE GSE ONE)'
City of Tigard Received
il y � Date/B s �J117A711111PermitNo.: 1G �:tie/'
13125 SW Hall Blvd.,Tigard,OR 97223 S J /_5'Jiit
UPI
Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 .e `` Date/B : Other Permit:
Inspection Line: 503.639.4175 " " Date Read/B
TIGARD p A. ) Ready/By: ® See Supplemental
Internet: www.tigard-or.gov "' a; q,c, t Notified/Method: EN Supplemental Information
R= REQ D DATA i AND 2 DWELLING
0 New construction ElDem fi igi , . % Permit fees*are based on the value of the work performed.
e"' )a",'" Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Othe3\t`\% %" equipment,materials,labor,overhead,and the profit for the
A� work indicated on this
., cATEGoftY o,F C bilcu io1V:; application.
El1-and 2-family dwelling Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9 0 ,_S'40 /2/4//9/7 New dwelling area: square feet
City/State/ZIP: / i0,,/ / diiC Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: '776‘,94..z.). ,7
:1f' �f�Sr Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
1 ItQUiTIEBtATli Ct lf i i''''''''C'',14''',11.$,E'' s a IST
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
: equipment,materials,labor,overhead,and the profit for the
?' i '' 'O %e r work indicated on this application.
'c.c/0 A.,/ CG?i✓772.4.1 6. C//vii.- 1 J=1572_,
Cy/ Valuation: $
.7,9.4S /Aj6-. Lz>e/2/� �j 0. g , 't-�" �, " Existing building area: square feet
��'� d G�d9n/ C� T X_. £721r�CcS- building square feet
New area:
'''''e. .�.P Em t R %,.0
. �' 'i ' : ** 111 /` 1,1 ber of stories:
Name: r kTe.. /'l,r• ,f/ Type of construction:
Address: ( ) : ) S i. . ('// 5 7 Occupancy groups:
City/State/ZIP: PO'-t/a 11 0 97 3'�.3 Existing:
Phone:(C i) 4(1.,2s 63-7).. Fax ( )
New:
®E 1 PLI O CT� N
Business name: 7l7Cf„2r✓ 7 /.e.,,tS contractors
subcontractors
xe
/ All coand subcontractors are required to be
Contact name: (�,�' � licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: q i CS S .ti. /1fI 5 / jurisdiction in which work is being performed.If the
City/State/ZIP: I'O;:-1 0 1c 9'7 2;�? applicant is exempt from licensing,the following reasons
Phone:(C II) ,,0,c7) Fax: :( ) apply:
E-mail: 7)1 Ic..„ G c )-
Business name: --7✓"Ai,j `.
BUILDING Pt '. i dulEe)S*
h'Address: oU J.L, 171l� 5. 44,,,., �, pleas�efertofeesche ,ice;
City/State/ZIP: 1' v f fc•� OA 7 7)�7 Structural plan review fee(or deposit):
Phone:(6_52,19" ...2 657j Fax ( ) FLS plan review fee(if applicable):
CCB lic.: Total fees due upon application:
,r Amount received: SP/. t0
Authorized signatu / ,�
!/ This permit application expires if a permit is not obtained
Print name: 11, r. � Date: /97 Pri /�-7
* within 180 days after it has been accepted as complete.
/ Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613T(I1/02/COM/WEB)
..
S
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: sq. ft.
jam.
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 OF SUBMITTAL #of`Plans Vil0 i* , .1 e° $, .. $
(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
$10.76 for each additional$1,000 or
Multi Family R-1 Occupancy 3 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 08/02/2016 2
Site Work Permit Application
Plan Submittal Requirements
Ti G A R D Commercial, Multi-Family and One- &Two-Family Dwellings
A site work permit is required for all commercial projects including new buildings, additions,
accessory buildings larger than 120 square feet, modular structures and multi-family R-1
occupancies. A site work permit is required for excavation, fill,grading,paving,retaining walls,
fire hydrants and fire department access on private property for work on individual lots not
covered under the subdivision development.
Note: A separate "plumbing" permit for site utility plumbing work is required for sanitary
sewer, storm sewer and potable water systems on private property. Please see the Site
Utilities - Plumbing Permit Application for plan submittal requirements.
1. SITE PLAN and vicinity map (fully dimensional, drawn to scale) showing the geographic
location labeled with:
A. ❑ map &tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ applicant phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Building pads (drawn to scale) with project location.
2. BUILDING PLAN submittal requirement: Three (3) complete sets, Civil only.
All details listed below shall be incorporated into the plans:
A. Site plan showing:
1) Required parking spaces and driveways.
2) A route, accessible to persons with disability, leading from the public way to an
accessible building entrance.
3) Accessible parking spaces and adjacent access aisle connecting with the accessible
route.
4) Curb ramps along the accessible route, curb, sidewalk and gutter.
5) Finish grade elevations along the accessible route.
B. Topographic survey plan showing grade elevations crossing the entire site.
C. Overall grading plan.
D. Utilities plan showing:
1) Fire hydrant location and pipe size if on private property.
2) If the building is to be protected with an automatic fire sprinkler system, show
location of the water service vault and the fire department connection (FDC)
within 70 feet of a fire hydrant.
3) Size of underground water service for the sprinkler system.
E. Erosion control plan complying with the requirements of the Clean Water Services
(CWS) agency showing:
1) Silt fence locations.
2) Bio-filter bags/other approved barrier material surrounding catch basins.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 3
3) Illustrations detailing the correct installation of the silt fencing and catch basin
protection.
4) Any other measures to ensure compliance with CWS standards.
F. Landscaping plan.
3. ADDITIONAL REQUIREMENTS:
A. Soils (geotechnical) report. A soils report is required for new buildings and additions
to contain the following:
1) The report shall address the potential of soil liquefaction and instability (OSSC
Sec. 1804.2).
2) Fills to be used to support foundation of buildings (OSSC Sec. 3301.1).
3) Foundation and lateral pressures exceeding 1,500 lb./sq. ft. (OSSC Sec. 1805).
B. Fire flow and hydrant worksheet.
C. Plan review deposit based upon project valuation.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 4