Permit (41) CITY OF TIGARD SITE WORK PERMIT
€ ." COMMUNITY DEVELOPMENT Permit#: SIT2018-00012
T I(ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/01/2018
Parcel: 2S 113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: PacTrust Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Modifying parking,landscaping,and pedestrian walkways,and constructing(1)new pedestrian walkway.
Contractor: FLYING H CONSTRUCTION CO Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 2533 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-925-1280 PHONE:
FAX: 503-678-4221
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 05/01/2018 $1,572.72
Plan Review 05/01/2018 $1,022.27
Type of Use: COM 12%State Surcharge-Building 05/01/2018 $188.73
Class of Work: ALT Info Process/Archiving-Lg$2.00(over 05/01/2018 $24.00
11x17)
Project Valuation:
$269,620.00 Erosion Control w/Development 05/01/2018 $311.40
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:
Fence:
Total $3,119.12
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 fog• •- - - • Q01-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.19:r or 1.800.332.2344...}Issued By:A ° " .
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. V V
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
RECEIVE �`eceived FOR OFFICE USE ONLY
Ci of Ti and
MUM
. `J g DateB : I i �f Permit No.: �_ ,' _ ._
� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 MAY 1 2018 DateB : ' Other Permit:
Ti G A R D Inspection Line: 503.639.4175 Date ReadyBy: Tuns: H See Page 2 for
Notified/Method:5"6
Internet: www.tigard-or.gov
lI Supplemental Information
CITY'OF TIGA' i
, , x e4 ark , O A H 1 � s ',f.,.1;41;‘..1.6.17.71-, et.:.—e".-1 i° "-. ! X 6 - t
❑New construction 0 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
�� b�� T = 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:
.i441-''''4
i ti�i a I, '�y �' V a
r . . (q a 0 , t.-i_® t. , Total number of floors:
Job site address: I(p(SSS +p 1(9 95 � 72rr�Ave. 1(0505 f�+ I b u7� New dwelling area: square feet
City/State/ZIP: p p('-�'i n,( , DR of 21 .. 54cupper' Garage/carport area: square feet
Suite/bldg./apt.no.: `Project name: 6He g 00005 (j a Covered porch area: square feet
Cross street/directions to job site: refockficaiion Deck area: square feet
Other structure area: square feet
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: W(� M 2 s ?J ��- Tax hi; Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,soverhead,and the profit for the
' '�'` ° ) 9I' o t ® i. work indicated on this app lication.
rip 0dl C11� Far�f(� and Q(1 rre, Valuation: $ 2. ‘9,(020
and scv► v) rade y (� �( , Existing building area: square feet
P VI wa )
G o h � a t � n P yt/to New building area: square feet
` �, ,, ""_
�r � �' `"'� � � "� �� 4r,;,... •&,:4.4'1:,'...`,71Number of stories:
«�._ -.moi fu(�"'sa,—3a„ ��.. .� �. �-�u -aat5-�- ,ff+s�. '�A�rm .`�:a� ate`,
•
Name: 'L �r,at _t.�'it e �d,k1 c, Type of construction:
Address: t Cj 3 0 S W 5 e Quo;C pkW A .ii ?j 60 Occupancy groups:
City/State/ZIP: rar t and t Op— 1'7 214 Q Existing:
t _
Phone:(601; ) W 24-—fo�0� Fax (5%) (O Z 71
New:
Business name: ,arne acv ,,
U�.LrJ(T/e, � All contractors and 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: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax: :( )
E-mail: 4-eC 44 e , 43 'QIG"tY 6 CV(Y)
.; t�r- `�`arnr,�.� �' � r ss.,';s/�.,z�6` 'aa a� „�• .�a��a �a. `'�.� Al
Business name: Fi 1 n 1,Vn�J'f uch of) �.r t, I.�l+r� l +
Address: Y Q 0 S 3 3 .,,s ,n
Structural plan review fee(or deposit):
City/State/ZIP: W i yQ nV 1 V19, oto- 9 7 0 70
FLS plan review fee(if applicable):
Phone:(5'03) 7$0—11 I(O Fax:( )
CCB lie.: ' p Li.(p l O' Total fees due upon application:
`
` Amount received:
Authorized signature: ✓�kA C .• km 5 This permit application expires if a permit is not obtained
((��,, within 180 days after it has been accepted as complete.
�
Print name: .fC \(e �o";y Date: Nf) 1 X201 L * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\SIT-PermitApp.doc 08/02/2016 440-4613 T(11/02/COM/WEB)
INCity of Tigard
r COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: 7,- c1T-- CX j
Site Address: i6 6S — 16C -S SW q-2-64 AV. Suite/Bldg#:
Project Name: f rk 7 41- Si ko ol;fuh .,3
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 1,0004 L. ,..44' hoLf7inj drLigki, 10,1“AO& ;AA 1 1/.1t-ti . u4NC“
n9 0^4 vi JTtit^ L,Hi kid 7.
[L ify site address/suite# exists and active in permit syste
River Terrace Neighborhood: ❑ `Yes lI No
[sand Use Case#: h h O 0l g' 000 12_
Ur PlanyMatch Approved Land Use:
Site Plan Landscape Plan ❑ Other:
Urban Forestry Plan ❑ Elevation Plan (
Building Height: Maximum Height V° �:.ku.4 - Actual Height ----
V41' Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business License:
F�xists: ❑ Yes ❑ No,applicant notified to obtain business license
[g
Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified 4K No Applied For: ❑ Yes ❑ No,stop intake
Notes: PF0 wkJ j• pig FiVi- -11 i)H''‘j i.[^J'iL, il) z.,,II rt",,,, Lvi1t i ,), 4r”
X31 tc1-:'^y tv 7 kvr.R& fkan ,,11-u( t ;1- Cvrrini-tr j;.
Approved by Planning: 5Cc Date: S 11
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: 57/1'3'
Site Plans: # 3
Building Plans: # 3
Building Permit#: 0.--En er building permit#above.
Workflow Routing: [E 1i ening ElEngineering ElPermit Coordinator I iTding
Workflow Sign-off: kW� �Si -off for Planning(include notes from planning review)
Le=i
Route Application Documents: tuilding: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: ..
By Permit Technician: A_ Date: =�/j/ij'
+I
I:\Building\Forms\BldgPermitRvwCOM WithLandUse 060116.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
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:
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
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse_070915.docx
City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Building & Fire Protection System Permit
6 � n i.D Appointment Checklist
1 PCermitontact RName:ecord#: 7�i�GAO t
/,�,. � � Phone #: (,533 6gK.-�''x.
c. Business Name: A�67 �I- Appt. Date/Time: ,s-/. t e. Kiri;ct
Site Address: ` J(5- - — /(.75 7,142Ave.Bldg/Suite #:
Project Name: P7- y. New Tenant? 0 Yes , No
Project Description: 4viro. oill s. 1...6,rtt: ,7710 1 ,hrj "ark.,1/gnd.rclo.syr irvol
Existing Use: -w Use:
0 MMD Required: X Yes 0 No Related Record#: Dglzr--(p0!)!a
APPLICATION SPECIFIC INFORMATION
i - GENERAL INFORMATION
Class of Work: �(S• 'T Occupancy Group: Type of Construction: V
Type of Use: 0�_"i k;.,.3 Occupancy Load: Oregon Specialty Code: ]3
SPECIFICS
Number of Stories: _9 Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
i , BUILDING SQ FT-SCHOOL CET OTHER SQUARE FOOTAGES
0 Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS
Sideyard Setback—Left Sideyard Setback—Front
Sideyard Setback—Right Sideyard Setback—Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access.Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor:
Total Project Valuation: $0'1�j �} -0
$ , Q DC Prov Rvw,COM TI—Ping
/ 5?� �� _ 'ermit Fee—Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2017)i �3 $ _ `_��y, r 12%State Surcharge
Project Valuation `'a �7 _,� L 'Ian$ Review,Structural
Up to$4,999 $0.00 $ __urvir` Plan Review,Fire Life Safety
$5,000-$74,999 $91.00 $ - __ Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $226.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $361.00 $ 3 Metro Construction Excise Tax
$ ,j School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ J/ Misc.Admin Fee
$ 3l/. Other: E,- Ir," ce-4-24 Staff: $ Other:
Date/Time: $ _ G_ , TOTAL FEES DUE
I:\Building\Forms\OTC_BUP_FPS_070117.docx 3i ` ` t'
Cut/
CF®
Generated: 2018-05-01 08:37:54
By user: matto
H:\Design\050 PBC\PBC SITE\194-196 ADA grading\H:\Design\050 PBC\PBC
Drawing:
SITE\194-196 ADA grading\C2 Grading Plan 2018-04-04.dwg
Volume Summary
Name Type Cut Fill Cut Fill Net
Factor Factor (Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
NEW
PARK full 1.000 1.000 27.92 81.73 53.81<Fill>
SW
196 full 1.000 1.000 43.45 3.65 39.80<Cut>
NW
196 full 1.000 1.000 21.83 66.20 44.37<Fill>
VOL
Totals
Cut Fill Net
(Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
Total 93.20 151.58 58.37<Fill>
* Value adjusted by cut or fill factor other than 1.0
Cut/Fill Report
Generated: 2018-05-01 08:37:54
By user: matto
Drawing: H:\Design\050 PBC\PBC SITE\194-196 ADA grading\H:\Design\050 PBC\PBC
SITE\194-196 ADA grading\C2 Grading Plan 2018-04-04.dwg
Volume Summary
Name Type Cut Fill Cut Fill Net
Factor Factor (Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
NEW full 1.000 1.000 27.92 81.73 53.81<Fill>
PARK
SW full 1.000 1.000 43.45 3.65 39.80<Cut>
196
NW
196 full 1.000 1.000 21.83 66.20 44.37<Fill>
VOL
Totals
Cut Fill Net
(Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
Total 93.20 151.58 58.37<Fill>
* Value adjusted by cut or fill factor other than 1.0
Cut/Fill Report
Generated: 2018-05-01 08:37:54
By user: matto
Drawing: H:\Design\050 PBC\PBC SITE\194-196 ADA grading\H:\Design\050 PBC\PBC
SITE\194-196 ADA grading\C2 Grading Plan 2018-04-04.dwg
Volume Summary
Name Type Cut Fill Cut Fill Net
Factor Factor (Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
NEW full 1.000 1.000 27.92 81.73 53.81<Fill>
PARK
SW full 1.000 1.000 43.45 3.65 39.80<Cut>
196
NW
196 full 1.000 1.000 21.83 66.20 44.37<Fill>
VOL
Totals
Cut Fill Net
(Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
Total 93.20 151.58 58.37<Fill>
* Value adjusted by cut or fill factor other than 1.0
Cut/Fill Report
ort
Generated: 2018-05-01 08:37:54
By user: matto
Drawing: H:\Design\050 PBC\PBC SITE\194-196 ADA grading\H:\Design\050 PBC\PBC
SITE\194-196 ADA grading\C2 Grading Plan 2018-04-04.dwg
Volume Summary
Name Type Cut Fill Cut Fill Net
Factor Factor (Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
NEW full 1.000 1.000 27.92 81.73 53.81<Fill>
PARK
SW full 1.000 1.000 43.45 3.65 39.80<Cut>
196
NW
196 full 1.000 1.000 21.83 66.20 44.37<Fill>
VOL
Totals
Cut Fill Net
(Cu. Yd.) (Cu. Yd.) (Cu. Yd.)
Total 93.20 151.58 58.37<Fill>
* Value adjusted by cut or fill factor other than 1.0
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16165 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Site Work SIT2018-00012
Inspection Type: Inspector:
499 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor