Permit (124) CITY OF TIGARD SITE WORK PERMIT
°I 4. COMMUNITY DEVELOPMENT Permit#: SIT2017-00029
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2018
T t ,�I.Cy g Parcel: 2S102BA00501
Jurisdiction: Tigard
Site address: 9748 SW TIGARD ST
Project: ELLIOTT Subdivision: None Lot: None
Project Description: Site work for a new 2,100 sq.ft.storage building.
Contractor: FRENCH CONSTRUCTION Owner: BAS PROPERTIES LLC
19430 NE HASSALO ST 19430 NE HASSALO H
PORTLAND, OR 97230 PORTLAND, OR 97230
PHONE: 503-730-4050 PHONE: 503-730-4050
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-Site Work 11/05/2018 $199.04
Plan Review 11/08/2017 $129.38
Type of Use: COM 12%State Surcharge-Building 11/05/2018 $23.88
Class of Work: NEW
Project Valuation: $12,000.00
Site Specifics:
Excavation Volume: cu.yd.
Fill Volume: cu.yd.
Impervious Surface: 2100 sq.ft.
Engineered Fill: No Soil Report Required:
Paving: Yes Grading:
Landscaping: Yes Site Prep:
Stom Drains: Retaining Wall:
Fire Underground: No Accessible Parking:
Fence:
Total $352.30
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 b - e Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may • ,.u' :.y .f the rules
or direct questions to OUNC by calling 50 .232.1987 or 1.800.332.2344.�� /iii‘1111111
Issued By: •
��
�%�l Permittee Signature:
aPOP-
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.
1
` Building Permit Application
Site Work
R ;; FOR OFFICE use ONLY
City of Tigard A� Received
I V Q — 2018 8 Date/By: Permit No.5-x-12 N?_e.
ill III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / U
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 j T51'J'HL)Daate Ready/By: J I See Page 2 for
Internet: www.tigard-or.gov B b (E1 pfr+otified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
El 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/alteratio eplacement ❑Other: equipment,materials,labor,overhead,and the profit for the
RY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling gbommercial/industrial Valuation: $
12/Accessory buildingNumber of bedrooms:
[2' ry 0 Multi-family
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATIONAND LOCATION Total number of floors:
Job site address: 11),---5 W .1 Ca ikD 5 1 New dwelling area: square feet
City/State/ZIP: fi S 6/)iz,(:) 0R- ot. "71,23 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: E LL1OT I` Covered porch area: square feet
Cross street/directions to job site: G &R i\j—r- S Deck area: square feet
Other structure area: square feet
REQUIRED DATA COA4kRCIAL-USE+CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2..'S 213/ 00 Cj O\ Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
I> PON OF WORK work indicated on this application.
Lel OVA\ 5 0 )(H 2 iM€143%1 ttL t kCk 11' Valuation: $
Existing building area: 50 x 2-1 square feet 1 ZOO
New building area: "rj GX t12 square feet too
( PRO Rttc ,:. b ) _
°3� ��WNETENANT �' Number of stories:
Name: AAs Frtft_L e 5 LLC Type of construction: N 1= N.4/
Address: I ki"30 tlQ E Il .$sc..'p S4. Occupancy groups:
City/State/ZIP: re, . 6 R. C\ )Z,j 0 Existing:
Phone:(563 ) 7 3 o ov)1,t2Fax:( ) New:
CJ "APPLIC 1 M CONTA ° RSO `. .. NOTICE ' ''
Business name: FRE N CO. (ON 5 T(2 kk ell 6 t..1 Lt..L All contractors and subcontractors are required to be
Contact name: 5 Elk k -N)c u licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: )C14-;o 17/ E 0 R SSA L jurisdiction in which work is being performed.If the
City/State/ZIP: 90 1..,.1 a a Oc , applicant is exempt from licensing,the following reasons
apply:
Phone:(5Q'5) 73 0 L.`d c Q Fax::( )
E-mail:
R * C(} , f
Business name: EI tUc 1,4 (bits 5 &IAC1 o4' L.L C. 4UILDINGPE°t I FEES*
Address: J 4‘s13 0 Ad E 14 A-55 4-i d ST ' (Please refer to jet schedule)
Structural plan review fee(or deposit):
City/State/ZIP: pt>(T I41N 0 0 R— C.k'72 3 o
Phone:( 507) 730 L.vD 5p Fax:( ) FLS plan review fee(if applicable):
CCB lic.: /0'3 ..‘'5)
Total fees due upon application:
Amount received:
Authorized signature: Alle / This permit application expires if a permit is not obtained
- I ��� within 180 days after it has been accepted as complete.
Print name: �V C 0 Date: Ile-5 - I Cii * 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)
/1101r.,: //rte. 6cr 4 ,-V74/9 j✓" "YA14 S eY*Agf die—/' in rfz'r(s 4cwt
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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
1 Concrete
❑ Other:
*Total new impervious area including all buildings, i7
sidewalks,and paving: 2 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 OF SUBMITTAL #of Pl t � s f, e mit Feel ,
$7004534-500.00 $51.09 minimum •
Alterat ons) Submi t tl is $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
$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
. 4
.
- a
City of Tigard: Site Work Permit Checklist
Page 2-Supplemental Information
Commercial,Multi-Family and One-and Two-Family flwejlinas:
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). /6q
Please complete all items below,unless otherwise noted.
Excavation Volume: cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) : L, I ) cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) cu.yds.
Retaining structure? (Check one) 0 Ro4
❑ CMV
- Con Crete
Other:
*Total new impervious area including all buildings,
sidewalks,and paving:
0
)7;r.. , n r"',A"�'='::{�...,.;�r.1.?:.,Ii;r r:.:,rr. ..FCS�a%g=r='+-%"?v+'`a: '- - -
L+, .a� .,+'.!�..,—•._� :lw._r r ..-y,.. ,.....;::i'r:r "":f:•:N/i x'...�;<�r_:;� r•.�,n,...... "'r'T:. :"•ftT3'."i:Tda Ai'n't
r,�, J r` li -f'....y.,'?Jr ..rJ '.,.!. rrat�r ,., R ;,ri;;r5;> - ;il.'i p• .>+Ja�R�r's•,�_s i..,:
'.:':T,:rr��'�.1%�".�." �=�..z:jrad}.',:•l��i:d,�9'rr.:.,A�t .:2-::��.1it:»_:m':t���+.✓.r, v.:,,: •��`''� r !:�: :.;;fi:i;?1"'�;Yril;;'.;:;:`;f''.j4'T,^�":!-: '?n
�J�'r .'�s!��..>•.�.."n�d: r..o.....�.. .:lG.c.;..,..::...5...,...•r...�-��e:'%ir,�f. "e's.�.d-..YortY.
Site Utilities Plumbing Work:
Complete the Plumbing Permit Application for site utilities plt.mbing 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 0 *Parking(including ADA)and Lighting
compliance Plan
Grading Plan and details *Landscaping Plan
Erosion Control Plan and details Sojis Report(if required)
Retaining Structures III
*Does not apply to One-and Two-family dwellings.
Plan Submittal: ��y. Permit Fee:
1l'Ja� i —_ -_ :�.f�( ' �:''�Sh'�'!!fJ: _ _" a7ya;' c:�r�v.:rv.:r.�.�a.,-1
: � � _.40f, ... ' vim.
, ._ 5:r;.:. _,_...i�. '.-'•r�.:..... :;..'::: - ,t:.. 7!?Tr� .:::d:T - t ! :,�..'''�''�''�"''''�'' �f�'G
�`':`%< ! 0lr; :;';;l:.i;7_ t0 :•..� 5.00 to 5500.00
' r;.:t:jt;'%rl,:;" , r::::lN' i',�7•, :': �.! $S1.f39 minimum permit fee
i y.S ;'Y:::-A1te A ,<S" 1 S•• ;r � SSOO.gi to 2,000.0f]
,', .. ::: ..:... :.. .':,,. b -':.; ti 551.09 for the first 5500.00 and
�``` ` " ` $2.69 for each additional 5100 or fraction
Commercial 3 thereof,to and including 52.000.00.
52,000.01 to$25,000.00 $91.44 for the first$2,000.00 and
Multi-Family R-1 Occupancy 3 S10.76 for each additional 51,000 or
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
58.06 for each additional 51,000.00 or
fraction thereof,to and including :
$50,000.00.
$50,001.00 io S100,000.00 $540.42 for the first$50,000.00 and
$5.38 for each additional$1,000.00 or
fraction thereof,to and including
5100.000.00.
S100,000.01 and over 5809.42 for the first S100,000.00 and
$4.49 for each additional S1,000.00 or
fraction thereof
BBuildineermits%1T-PermitApp.doc 08/02r2016 2
•
1
• City of Tigard • COMMUNITYDEVELOPMENT DEPARTMENTH i_, i
1114 11
Request for Permit Action ,'R 3 2018
q �..
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti e�b Q�(1��Ie 5
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ I IOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
OOP ' MOV REPLACE CO croR"ON PERMIT-cdtrni4 cancel permit).
Permit#: S/% .--21,./ 7-£V(1 -2 c
Site Address or Parc- -• -__ , - 7767,9-72„6 S 7
Project Name: CG L.-/ 0 7/
Subdivision Name: Lot#:
EXPLANATION: '5 AS 1 vita \ o„,, „r- -..b, ( L
1\
Signature: ' 4.... Date: 2e i
Print Name: e-r-r, N -
Refund Policy 1i
1. The city's Community Development Director,Building: ficial or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092314.doc
City of Tigard
14 v COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - With Land Use
4' Ft :e ':7,..,_,7,-_,7Lbw_ _..�_-- ,,k,-. 4...E3m�'Ave. .= ztt a ---vii '? .1.4 .4` .c`.:,.cX,. a'3Yt,av'r,173 ,r, - d,,- -21
Building Permit #: 3" '^`-rk17-6wazei --�
Site Address: - / /` j- Suite/Bldg#: \ 0
Project Name: - Ezr.zc
ds
(Name of c mmercial business occupying the space. If vacant,enter Spec Space.)
Planning Review J
Proposal: /wit) s /X s_�rhf//d �P
rc
Verify site address/suite# exists and active in permit syste
* , ver Terrace Neighborhood:
,� An ❑ Yes No
P and Use Case#: /Vl if L _oj-3r O4j 4 CLca
R c r - -3
Plans atch Approved Land Use:
pP `�l /
Site Plan
` , kandsca e Plan l ther:
lban Forestry Plan lavation Plan
Building Height: Maximum Height a& Lig- Actual Height ‘,..2 O
0 i onditions Met: 0 Prior to Submittal ❑ Prior to Permit Issuance
1'I Business Licen
Exists: Yes ❑ No,applicant notified to obtain business license
ublic Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified IBJ No Applied For: ❑ Yes 0 No,stop intake
Notes:
Approved by Planning: _� Date: 1/rah)—
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: ///11p 7
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above.
Workflow Routing: ening trigineering [ - Permit Coordinator ceding
Workflow Sign-off: [ S1 off for Planning(include notes from planning review)
Route Application Documents: ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
r
By Permit Technician: _ _ '�.--`E - Date: (7(5/7
I:\Building\Forms\BldgPermitRvw COM_WithLandUse 060116.docx
Engineering Review
4- %
.E—Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
O Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
,Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes edNo
Assess Water Quantity Fee in-lieu: 0 Yes 6-No
LIDA Facility on lot: 0 Yes Ja'No
JNOT Approved by Engineering: /hi, Vit-- W • Date I •
Notes: f f t&- ) ?LA1i 1 NCR (.....Aid Vii-- 10 D TE o-,-- 5 PL
Fiv- v tu., i rPr <-6714-10-6 P- ( 9t) iz2)
Approved by Engineering: `- Date: Vie, /f 7
Revisions (afte Building Submittal only) (� Reviewer at
Revision 1: Approved 0 Not Approved Pi 11,01.- ti..) . /I/ (
Revision 2: 0 Approved El Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
O Approved,NOT Released: -1M)OA/ , *Date: /1 f)3)/7
Notes: .r t� O\ 44.1b
Revisions (after Building Submittal only)
Revision Notice 1: Date Sentio Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
76DC Fees Entered: Wash Co Trans Dev Tax: CIYes U,4/A
/ Tigard Trans SDC: 0 Yes 4.f. /A
Parks SDC: 0 Yes i-:- /A
OK to Issue Permit
Approved by Permit Coordinator:—AtDate: It I 4 1 7
I:\Building\Forms\BldgPermitRvw COM_WithLandUse_070915.docx