Permit Support Document (20) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ,.,
71 _. Request for Permit Action SEP1
1, 2018
T I+G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
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TO: CITY OF TIGARD
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Building Division
13125 SW Hall Blvd.,Tigard, OR 97223 ////I,//F 6
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner n Applicant n 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).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: 5T T AO i 3 • ODD ,Zr.
Site Address or Parcel#: MD(�e) ,SGJ Tit tltit e.,7
Project Name: /7 cd -1/yiG- 7 /'dcs / '/L a el 1&✓/d5-e_
Subdivision Name: �Lot#:
EXPLANATION: 5c, -r * pry/441-f- r,,, ,,,,,.,,,7‘-‘, V� eco s a,-j
� t.,*2/ c-'- 6_1. act of r'i 4,*,-- /tiif f,,,s GP -'r/ 114 r
I-4 w-1– c s jA ).4L /c�.Le 1r-re" -s ..S r7T e/f -Q')0 S , ..vv
Signature: , Date: i 7//// --
Print Name: 'Vt.Iy. 0cl.i4kt,•-e€17/
Refund Policy
1. The city's Community Development Director,Building Official 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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`7 l't (f By ir; Route to Records: Date 7/ /4, /f By lir"."‘"';
Refund Processed: Date 4/ .,9 By,,l Invoice Processed: Date By
Permit Canceled: Date 4, //�-' By arcel Tag Added: Date By
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Plutst. f-rtrilit -71rialikrlf k /
Building Permit Application imv 0 I
Site Work FOR OFFICE USE("II
City of Tigard SEP 102.e'3 Received
Date/By: (49 (j , ll Permit No..V73/10/,_,...,„6:244.
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
NI I Phone: 503.718.2439 Fax: 503.598.1960 , . Date/By: Other Permit:5;72%0f/5.-OC:6#4.f
Inspection Line: 503.639.4175 Date Ready/By:
him
TIGARD ,. ' : : 1 El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK - ,. REQUIRED DATA:1-AND-2-FAMILY DWELLING
yNew construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION ',4'.-1/4:
'' '''' Valuatio • $
0 1-and 2-family dwelling 0 Commercial/industrial
mber
0 Accessory building 0 Multi-family Nuof rooms:
0 Master builder yl Othen-TOZ,4/..../23/(40C -Z Number of bathrooms:
JOB SITE INFOpIATIO$'ANDL&ATION 4- Total number of floors:
Job site address: jZ,06.0 .5v.) 1)g so gHood,i New dwelling area: square feet
City/State/ZIP: .7-1 6/4/14 ,) D>2._ 1727-3 Garage/carport area- uare feet
Suite/bldg./apt.no.: N. Project name:77 1112 OW. ' ...At,/_ Ali F Covered porch ea: squar eet
Cross street/directions to job site: 0 7 ' 4 4.-: .7fiv 4". .. 11— Deck area: square feet
Vti 00 0 Al P$4/2.44 Other structure area: square feet
EIXQUiltil)DATA:COM4CWe.,USWECKLIST
Subdivision: /4)p Lot no.: iS2/.2\ Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 7-• /oz./5 e 632-oo Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
'..:,: DESC' I le ibN4CWO!tr.,.14:::': .074„, , work indicated on this application.
..0.,,,e, +.4‘.., -,,... '-' '.,:.i- 5,V.6.
&Ng LAI 1-(1--ivz_ hP.-.:61/40/1/46-t— Ahlb Valuation: $ 1161 6,75,01)
Pigori-tprizi p.14 1 /2 4 o61E ('• 093 ierms) Existing building area: 0 square feet
New building area: square feet
VBTROP, OWN& HQ•z NA10.:' Number of stories: Ai//lJt
Name: A4 t-7-72-t? Type of construction: e"1pgz7724)$$
Address: 4,o ) "it /2_01/4 is/2 /.....W g Occupancy groups:
City/State/ZIP: FPO rz,--r i_IfkrAt) 012. /7 Z 3 2. Existing: N/A
Phone:(6j) ) 9/.3 —76-70- Fax:663 .7477 — / eit-7 New: N/A
4ilicANT mik, :!! 0
c...1)N- rAclIPERSON44' ;,"„' OTICE --,,,y
Business name: C/ry or 77A446, All contractors and subcontractors are required to be
Contact name: cp424.4‘ e,ras.e 0--re g_. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /?,.I Z 5 6 u) p•i A L[ ez_vie jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: 776,1404/Z4 ele/ q Izi3
apply:
Phone:(5:0 a 7/5 _ 2 7 0,51Fax: :( )
E-mail: istoo"-/o‘ a -/i 1 of ç)
OR
Business name: a 1-e_ar/ 4 - 7, BUILDING PE' V -•:1,
Address: 41 5 6,& I‘145.7 0-e
-6A1- rkt
e-19 ka • /20• ,,,,, ,,„,,,,, ,:,-(pkase-c4 fr.rte fte, , )
Structural plan review fee(or deposit):
City/State/ZIP: .7-;A "'T-2),fs.1. i O/ - 9 73 e 3
FLS plan review fee(if applicable):
Phone:(60.3 74 47.... /9($ Fax:6389 24?— 22o 3
Total fees due upon application:
CCB lic.:
6t,i10 44-Z15Ct7L> Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: (l g..1,,A 7-r#6,..e.,eTt."(4. Date: gliet(4f3
* Fee methodology set by Tri-County Building Industry
Service Board.
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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: jot cu.yds.
Grading Volume:
(Soils report required for>5,000 cu.yds.) 4 77 cu.yds.
Fill Volume:
(Fill exceeding 12"in depth shall be compacted to
90%of maximum density) 715 cu.yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
Concrete
❑ Other:
*Total new impervious area including all buildings,
sidewalks, and paving: 04 6 46 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:
T1PE OF SUBMITTAL #of Plans �a1u IIi am . ; PeAlit „;:
(New,Aciditfinnc 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
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.
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.
11111 -
im Site Work Permit Application
Plan Submittal Requirements
T 1 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 setsCivil 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
City of Tigard
IIIr COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A RD Building Permit Review — Commercial - With Land Use
Building Permit #: _5--_,,--7--,&,), 1- oo0. .
Site Address: 420(70 S0 ,_ Suite/Bldg#:
Project Name: , f `
4 //r/ � �i l/Y A_�j Lai/// _ 7
(Name of commercial business • cu vying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: .hjSlidrt C'iht-A-1) 1 ff-G7yt
7-
041
site address suite#exists and active infy / permit system
er Terrace Neighborhood: El Yes No
n xand Use Case#: C R20)-- onw/
or PlanyMatch Approved Land Use:��
e Plan k Landscape Plan Offer:
_ I1Q Urban Forestry Plan taJtevation Plan
P1' :utlding Height: Mnum Height Ac al Height
yCn ditions Met:
0hrior to Submittal Prior to Permit Issuance
siness Licens •
E 'sts: LId" Yes ❑ No,applicant notified to obtain business license
Public Facilities rovementF
m I) Permit: inP-1,2-6l i3GX�/s
Required: Yes,applicant was notified ❑ No Applied For: 0 Yes El No,stop intake
Notes:
Approved by Planning: — Date:Date: CVO/ j
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
Building Permit Submittal
Original Submittal Date: 7 %o!,'r
Site Plans: # 3
Building Plans: # 97
Building Permit#: Enter building permit#above.
Workflow Routing: Planning 1`J Engineering E ermit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: 12 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
ikt4
Notes:
By Permit Technician: i
/ �' Date: Vd//
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Engineering Review
Slope at building pad:
,8'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 .0"No
Assess Water Quantity Fee in-lieu: ❑ Yes .0'No
LIDA Facility on lot: Ill Yes �'No
0 NOT Approved by Engineering: Date
Notes:
7 Approved by Engineering: /14 ] OG 1L 1.4-) Date: 7 1(//8
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 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:
JRevision Notice 3: Date Sent to Applicant:
J JCJ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes �+/A
((// Tigard Trans SDC: ❑ Yes ►%-N/A
Parks SDC: ❑ Yes N/A
OK to Issue Permit q
• e:
` l/vedb Pet Coordinator:
PP Y
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