Permit (120) CITY OF TIGARD SITE WORK PERMIT
710 ' COMMUNITY DEVELOPMENTif _ Permit#: SIT2017-00013
Date Issued: 12/20/2017
T f c,A.R f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 F parcel: 2S 10X600200
Jurisdiction: Tigard
Site address: 13115 SW PACIFIC HWY
Project: Specialty Retail Subdivision: None Lot: None
Project Description: Site work for 13,222 sf specialty retail store. 9/11/2018: REPRINT permit to correct site address.
Contractor: MCPHERSON CONTRACTORS INC Owner: TIGARD PACIFIC RE LLC
3501 SW FAIRLAWN STE 100 C/O LEADERSHIP CIRCLE LLC
TOPEKA, KS 66614 1521 OXBOW DR STE 210
MONTROSE,CO 81401
PHONE: 785-273-3880 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 12/19/2017 $2,380.92
Plan Review 07/11/2017 $1,547.60
Type of Use: COM 12%State Surcharge-Building 12/19/2017 $285.71
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 12/19/2017 $36.00
11x17)
Project Valuation: $450,000.00 Info Process/Archiving-Sm$0.50(up to 12/19/2017 $7.50
11x17)
Erosion Control w/Development 12/19/2017 $461.40
Site Specifics:
Excavation Volume: 400 cu.yd.
Fill Volume: 1800 cu.yd.
Impervious Surface: 42000 sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Yes Accessible Parking: Yes
Fence:
Total $4,719.13
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 O NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ill # - Permittee Signature: QN -71/14./x'`1-770s/
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.
CITY OF TIGARD SITE WORK PERMIT
COMMUNITY DEVELOPMENT Permit#: SIT2017-00013
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2017
Parcel: 2S102CB00200
Jurisdiction: Tigard
Site address: 13125 SW PACIFIC HWY
Project: Specialty Retail Subdivision: None Lot: None
Project Description: Site work for 13,222 sf specialty retail store
Contractor: MCPHERSON CONTRACTORS INC Owner: TIGARD-TUALATIN SCHOOL
3501 SW FAIRLAWN STE 100 DISTRICT 23J
TOPEKA, KS 66614 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 785-273-3880 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 12/19/2017 $2,380.92
Plan Review 07/11/2017 $1,547.60
Type of Use: COM 12%State Surcharge-Building 12/19/2017 $285.71
Class of Work: NEW Info Process/Archiving-Lg$2.00(over 12/19/2017 $36.00
11x17)
Project Valuation: $450,000.00 Info Process/Archiving-Sm$0.50(up to 12/19/2017 $7.50
11x17)
Erosion Control w/Development 12/19/2017 $461.40
Site Specifics:
Excavation Volume: 400 cu.yd.
Fill Volume: 1800 cu.yd.
Impervious Surface: 42000 sq.ft.
Engineered Fill: Soil Report Required: Yes
Paving: Yes Grading: Yes
Landscaping: Yes Site Prep: Yes
Storn Drains: Retaining Wall:
Fire Underground: Yes Accessible Parking: Yes
Fence:
Total $4,719.13
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: r_11,21.7,..„4„ 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.
Building Permit Application
.Site Work RECEIVED FOR OFFICE USE ONLY
City of Tigard Received y
II -
Date/By: i op /7 / Permit No.:5I7--A0/7_06e,/3
'l 13125 SW Hall Blvd.,Tigard,OR 9722,3,, 6 �jj
Phone: 503.718.2439 Fax: 503.598.1 G Plan Revw /�
Date/By:
�3 Y`l?�l�G`( - Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready L ( Anis:
Internet: www tr and or ov OF TIGARD See Page 2l for
g g Notified/Method:
�y'� r�/�� t 7 Supplemental Information
° l 7Q)�ZcYstA ' n
Permit fees*are based on the value of the work performed.
®New construction ❑Demolition
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
' Y „1:,..,,:,,,i.,,,, ,,*;,,,.,,,,,,
1 ” LL ' work indicated on this application._ � 's {C :_ . RO - 1l ;
❑ 1-and 2-family dwelling IDCommercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
,I ' 1 �I a 11 •i ,A Total number of floors:
Job site address: 13125 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP: Tigard OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Specialty Retail Covered porch area: square feet
Cross street/directions to job site: SW Pacific Highway and School Street Deck area:
square feet
Other structure area: square feet
200 �' � � � .. �: A� ..
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S102CB00200 Indicate the value(rounded to the nearest dollar)of all
I "r, � �_. 1 equipment,materials,labor,overhead,and the profit for the
�! ,g ', � N '` work indicated on this application.
New single story specialty retail store;assocaited site work including parking Valuation: $ 450,000(Site Only)
lot,site furnishings and landscaping Existing building area: n/a square feet
New building area: 13,222 square feet
tom: � , 4. .v
i" a ! _ .,, rt °°® Number of stories: 1
Name: Vitamin Cottage Natural Foods Market Inc. Type of construction:
Address: 12612 W Alameda Parkway
Occupancy p y groups:
City/State/ZIP: Lakewood,CO 80228
Existing:
Phone:(303 ) 986-4600 Fax ( )
New:
>
Business name: DOWL `... 41 .<.,. ',. ..
All contractors and subcontractors are required to be
Contact name: Matthew Zinzer licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 720 SW Washington St Ste 750 jurisdiction in which work is being performed.If the
City/State/ZIP: Portland OR 97205 applicant is exempt from licensing,the following reasons
apply:
Phone:(971 ) 280-8654 Fax::( )
E-mail: mzinzer@dowl.com
Business name:
Address. > ? 47,,...-',,,, ' - .FP ergr e.che' it:,-
j.S`4 / Sit,/ i,..141 e„4,0/�1 /41
City/State/ZIP: eprteci, ies Structural plan review fee(or deposit):
Phone:(7rs) o Fax:( ) FLS plan review fee(if applicable):
CCB lic.: ‘t. 7//4, s�—
Total fees due upon application:
Authorized signature: d�� Amount received: 547 epd
X8C This permit application expires if a permit es not obtained
Print name: �{ Date: { within 180 days after it has been accepted as complete.
MaLt il'2Ll �Ij l7 * Fee methodology set by Tri-County Building Industr
Service Board.
I:\Building\Pennits\SIT-PermitApp.doc 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: 400 cu.yds.
Grading Volume:
(Soils report required for>5,000 cu. yds.) 1800
cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to 1800
90% of maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 42,000
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:
x❑ Site Plan with Vicinity Map showing ADA El *Parking(including ADA) and Lighting
compliance Plan
x❑ Grading Plan and details El *Landscaping Plan
❑x Erosion Control Plan and details
❑ Soils Report(if required)
❑ Retaining Structures ❑x Fire Line
*Does not apply to One-and Two-family dwellings.
Plan Submittal: Permit Fee:
TYPE OF SUBMITTAL #of Plans r
ti3 .. :
(New,Additions or Required at $.00 to$500.00 ..
$51.09 minimum permit fee
, Alterations) 7 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
One-&Two-FamilDwelli3 $25,000.00.
y n g $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.doe 03/08/2016 2
City of Tigard
III II
COMMUNITY DEVELOPMENT DEPARTMENT
s
T I G A iz D Building Permit Review - Commercial - With Land Use
Building Permit #: i -1-• -i /7-coo / 3
Site Address: x'3125 St) PG? ►G i4\Aii Suite/Bldg#:
Project Name: Si S ..e3tOli IN, I2efn t 1
(Na e of commercial Jusiness occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Ninpi Ci rc;cAI it
'Verify site address/suite# exists and active in permit system.
g' River Terrace Neighborhood: ❑ Yes ./<1 No
Land Use Case#: 3 D ' >10-C I M MD2bc7-,. )1c1
Plans Match Approved Land Use:
IK,Site Plan ❑ Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
NIABuilding Height: Maximum Height 4 E Actual Height 2S
Conditions Met: ❑ Prior to Submittal Prior to Permit Issuance
Business License:
Exists: ❑ Yes No,applicant notified to obtain business license
Public Facilities Improvement (PFI) Permit:
Required: Yes, applicant was notified ❑ No Applied For: ,. 0
Plat' (`�, Pp � Yes ❑ No, stop intarke �Notes: a° rI iSs until Bowl P•. s' Die.-10 �.SS1'.i_l.per
Approved by Planning: I. . to _ �! Date:10 "7
Revisions (after Building Submitta •nly) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 19//7
Site Plans: #
Building Plans: #
Building Permit#: tenter building permit#above.
Workflow Routing: Planning Engineering 'ermit Coordinator ..11--Building
Workflow Sign-off: 2r—Sign-off for Planning(include notes from planning review)
Route Application Documents: EEilding: original permit application, site plans,building plans, engineer and
' rr beam calculations and trust details,if applicable,etc.
Notes: o yp�.-±0 liAl RI
,7i ,[�uY�/l
_*„...)
By Permit Technician: _(> �
�• �0-44.4....tQ./ Date: 7/6
1:\BuildingTonus\BldgpennitRvw_COM_WithLandUse 070915.docx
Engineering Review
L lope at building pad: 3%
12°13FI Permit#:
pc-o/c, _ O-�
❑ Conditions "Met"prior to issuance of building permit
Easements (encroachments) per engineering conditions of approval and plat (not typical on SDR/CUP)
[Er-Water Quality/Quantity Facility: ��
Assess Water Quality Fee in-lieu: El Yes L'f No
Assess Water Quantity Fee in-lieu: ❑ Yes Er No
LIDA Facility on lot: ❑ Yes 12/No
IQ NOT Approved by Engineering: (( /t 5N�[. Date 7—•
Notes: s `t Ir.1 ��V >:�.�► ✓Awd pm1,4`GE. A Hne 1%.1G.1'NA1.0.3
t lay- ' !9 >,ot Pi i Pa->",,r
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes: ' v
Revisions (after Building Submittal only) WO'
Revision Notice 1: Date Sent to Applicant: ///.9//Z £-` €
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
?4-1'DC Fees Entered: Wash Co Trans Dev Tax: E Yes N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes >1.,N/A
AIK to Issue Permit
Approved by Permit Coordinator: Date:/ Er'-'f
I:\Bui]ding\Fonns\B1dgPennitRvw_COM_W ithl.andUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13115 SW PACIFIC HWY, TIGARD, OR, 97223 October 16, 2018 at
10:33:23 AM
Record Type: Record ID:
Commercial - Site Work SIT2017-00013
Inspection Type: Inspector:
499 Final inspection Chip Barnett
Result:
FA I L
Comments:
Provide planning and engineering department approvals prior to SIT permit
CWS approval as been received for Erosion
Violation Summary:
Inspector Contractor