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NEW COMMERCIAL/INDUSTRIAL BUILDING PERMIT SUBMITTAL COVER LETTER This packet is an effort to expedite the plan review process. Please review and complete the documents in this packet to complete the permit submittal process. CONTRACTORS: Please submit for permit through the State of Oregon E-Permitting system. With your submittal, include the following: o Construction documents/plans *list deferred submittals on front page o Site plan o Civil plans o Engineering calculations o COM CHECK reports o Geotechnical report o Completed New Commercial/Industrial Building packet Thank you for helping us provide timely plan reviews. Sincerely, The City of Woodburn Building Division CITY OF WOODBURN Building Department 270 Montgomery St Woodburn, Oregon 97071 (503) 982-5250 www.woodburn-or.gov ---PAGE BREAK--- COMMERCIAL/INDUSTRIAL DEVELOPMENT INFORMATION SHEET This form is to be filled out complete and included in the plan review submittal package for all commercial and industrial projects. If an item does not apply, indicate so in the space provided. PROJECT ADDRESS: APPLICANT CONTACT NAME: _ APPLICANT PHONE NUMBER: _ LAND USE CASE NUMBER: _ IF EXISTING BUILDING, IS THlS A CHANGE IN USE: PROPOSED USE OF BUILDING: TOTAL GROSS SQUARE FEET OF BUILDING FLOOR AREA; SQ. FT. TOTAL SQUARE FEET OF BUILDING ROOF AREA; SQ. FT. TOTAL SQUARE FEET OF ADDITIONAL IMPERVIOUS SURFACE, PARKING, SIDEWALKS ETC.; SQ. FT. IF THIS IS AN EXPANSION OF EXISTING BUILDING, SQUARE FOOTAGE OF ADDITIONAL AREA; SQ. FT. NUMBER OF ADDITIONAL EMPLOYEES: ADDITIONAL WATER USAGES (PEAK GALLON PER DAY): NEW SANITARY SEWER SERVICE SIZE; INCH. NEW DOMESTIC SYSTEM METER SIZE; _INCH. LANDSCAPING IRRIGATION SYSTEM METER SIZE; INCH BUILDING FIRE SPRINKLER SYSTEM SIZE AT CITY MAIN; INCH BUlLDING FIRE SPRINKLER SYSTEM SIZE AT BUILDING; INCH DOES THE PROJECT INCLUDE ANY WORK IN THE PUBLIC RIGHT-OF-WAY OR INSTALLATION, EXTENSION OF CITY MAINTAINED FACILITIES; YES, NO IF YES, TYPE OF WORK AND DOLLAR VALUE OF WORK; _ _ ---PAGE BREAK--- The applicant shall abide by all standards, rules, regulations, ordinances, and policies of the City of Woodburn relating to public improvements as now exist and as hereafter change or are amended. The applicant shall comply with attached Generals Conditions for this application and permit. TOTAL FEE AMOUNT: $ Permit Number Date APPLICATION & PERMIT TO CONSTRUCT A PUBLIC IMPROVEMENT SEWER STREET WATER OTHER DATES DURING WHICH IMPROVEMENT IS TO BE CONSTRUCTED: (FEE CALCULATED AS PER ORDINANCE #1795) SIGNATURE OF APPLICANT: ADDRESS: Date Receipt No. PERMIT APPROVED BY: ADDITIONAL CONDITIONS: (FOR CITY USE ONLY) The undersigned hereby makes application to construct the following additions, alterations, or extensions to public facilities (separate applications are required for each type of improvement): IMPROVEMENT (Plans must be submitted): LOCATION: CONTRACTOR(S) NAME: CONTRACTOR(S) CCB LICENSE: CONTACT PERSON NAME AND PHONE NUMBER: ESTIMATED VALUE OF IMPROVEMENTS: TYPE OF IMPROVEMENT: (FOR CITY USE ONLY) STORM DRIVEWAY APPROACH SIDEWALK ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT GENERAL CONDITIONS FOR APPLICATION & PERMIT TO CONSTRUCT A PUBLIC IMPROVEMENT Division 1. Generals 1. All work under this permit shall comply with the approved plans & special provisions, City of Woodburn Standard Specifications & Drawings, and the General Conditions for Franchise Utility Permits. 2. Plans are approved in general only and do not relieve the applicant from completing the construction improvements to the City's standards and specifications. 3. This permit is being issued ONLY for work performed in the Public Right- of-Way under the jurisdiction of the City of Woodburn and in Public Utility Easements under the jurisdiction of the City of Woodburn. All work performed on private property and/or other jurisdictions will require the applicant to obtain the appropriate permits and/or approvals required. 4. Only Contractors with a current Construction Contractor’s Board (CCB) license in the State of Oregon shall perform work within the Public Right- of-Way and/or Utility Easements. 5. Notify the City of Woodburn Public Works Department 48-hours prior to beginning construction, [PHONE REDACTED]. Any work done without the proper inspection will be subject to rejection. 6. All underground utilities shall be installed with a minimum vertical separation of at least 1-ft. from existing water, sewer and storm pipes. 7. Applicant shall install a ‘tracer wire” or other similar conductive marking tape or device, if installing any non-conductive, un-locatable underground facility, to comply with the Oregon Utility Notification Center, one call system (per OAR 952-01-00700). 8. The the responsibility of the permit holder to understand the limitation of the UL markings, and to undertake all necessary precautions and diligence to avoid damage and impairment to any private or privately-maintained underground facilities. 9. The Applicant holder or Applicant’s authorized representative shall be responsible for all damages related to work done under this permit, including, but not limited to damage to “unlocatable” underground facilities. All construction sites are to be restored to their original or better condition where affected by construction. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 10. Provide a traffic control plan and install traffic control devices in accordance with the current the guidelines set forth in the current edition of the Manual on Uniform Traffic Control Devices (M.U.T.C.D.) and the Oregon Temporary Traffic Control Handbook, as it applies to the project. Use as many traffic control devices as necessary to make a safe work site for the Public and construction crews at all times. 11. Leave work area in a clean condition, free from litter and debris, at the end of each workday, or more frequently if directed by the City Inspector. 12. Any changes to the approved plans shall be approved by Project Engineer and City Engineer prior to making the changes in the field. 13. All residents shall have uninterrupted access to their properties and to public roads. All streets, driveways, and sidewalks shall be open to the public at the end of each work day. 14. Construction work and activity shall be limited to Monday through Friday from 7:00 am to7:00 pm, excluding legal holidays. Division 2. Materials 1. The use of materials different from the approved plans, permit specifications, or the City Standard Drawings & Specifications is not allowed, unless they are submitted and approved by the City Engineer prior to their installation/construction. Division 3. Site work 1. All concrete and asphalt to be removed for installation of replacement structure shall be saw cut vertically to ensure neat vertical face to adjoin new. All damaged concrete sections shall be saw cut to the next joint and the panel replaced in its entirety. 2. Do not trim, cut or in any way disturb any trees, shrubbery, and other vegetation without the approval of the City Engineer. 3. Remove and dispose all waste materials of debris in an approved and “Permitted” landfill. 4. All underground work in the Public Right-of-Way shall be properly covered and/or surrounded with caution tape to protect the Public. 5. The permit holder shall comply with the approved erosion and sediment control plan at all times. 6. All damaged or removed street signs shall be replaced by the applicant. Installation shall be according to the current MUTCD standards and shall be completed no later than the end of the work shift. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 7. Street Closures are issued through the Woodburn Public Works Department, [PHONE REDACTED]. 8. Existing property pins and survey monuments shall be preserved. When disturbed by construction activities, they shall be replaced/reinstalled by a Licensed Professional Land Surveyor. 9. “Sidewalk Closed” signs shall be placed at all intersections leading to the sidewalk where work is being performed. Division 4. Streets 1. Pavement cutting is allowed only in areas specifically approved by the City Engineer or Field Representative. 2. Open cutting of pavement will be allowed in areas approved by the City, under the following conditions: a) Trench backfill shall be 1”-minus gravel or crushed rock compacted in 8” lifts to 95% AASHTO T-180. b) The asphaltic concrete replacement shall be full depth thickness, as per existing level 3, ½” Dense graded asphaltic concrete mix in accordance with the 2015 Oregon Standard Specifications for Construction. The edges must be saw cut, properly prepared, and sealed upon completion. The trench shall be temporarily patched with cold patch material if the surface repair is not to be immediately completed. Surface restoration shall be done in accordance with the City of Woodburn “Trench Cap” detail No. 3800-5. c) Width of trenches in which pipe is to be laid shall be twenty-four- inches (24”) greater than the diameter of the pipe, unless permission is obtained from the City Engineer. d) Open trenching length shall not exceed one-half of the street width. e) Before paving, proof of passing compaction tests on the compacted rock must be provided to the City Inspector. f) No trench shall be left in an open condition overnight. When approved, underground work in the area of paved surfaces shall be covered by steel plates that are capable of supporting traffic loads, with hot or cold mix along all edges, and pinned to prevent displacement of the steel plates. Steel plates shall be daily inspected, any necessary repairs completed on a timely basis, and shall not remain for over 48-hours without written permission from the City. A “SLOW” and “BUMP” sign shall be placed at each side of the steel plating. 3. The staging of materials on the Streets is not allowed. This includes but is not limited to, rock, backfill materials, spoils, construction supplies, etc. ---PAGE BREAK--- CITY OF WOODBURN PUBLIC WORKS DEPARTMENT 4. Existing roadway traffic markings are to be replaced to original or better condition where damaged by construction. Division 5. Water 1. Only City staff can operate live water valves and Fire Hydrants. Notify the City of Woodburn prior to the need for the operation of live water valves. 2. The minimum vertical separation between the water line and any conduit shall be at least one-foot. Division 6. Sanitary Sewer 1. The minimum vertical separation between the Sanitary Sewer line and any conduit shall be at least one-foot. Division 7. Storm Sewers 1. The minimum vertical separation between the Storm Sewer line and any conduit shall be at least one-foot. ---PAGE BREAK--- Form updated 9/2019 Page 1 City of Woodburn Application for Water/Sewer Service SERVICE ADDRESS: Apt/Unit/Suite SERVICE REQUESTED: ☐ STANDARD WATER/SEWER ☐ CONSTRUCTION – WATER ONLY SERVICE START DATE REQUESTED: Applications submitted and approved after 3 pm will be connected the next business day. APPLICANT’S INFORMATION Legal Name: Mailing Address if different than service address: Authorized contact, if account is under a business Previous Service in Woodburn: ☐ Y ☐ N If yes, what address: Phone Number: E‐mail: ☐ CO‐APPLICANT’S INFORMATION ☐ AUTHORIZED TO RECEIVE ACCOUNT INFORMATION Legal Name: Previously Lived in Woodburn: ☐ Y ☐N If yes, what address: Phone Number: E‐mail: If applicant is not the owner, please complete the following owner’s information: PROPERTY OWNER’S INFORMATION Name: Mailing Address: Phone Number: E‐mail: PROPERTY MANAGEMENT COMPANY INFORMATION (if applicable) Name: Mailing Address: Phone Number: E‐mail: I hereby agree to pay all bills for such service when due, and abide by all Ordinances regulating the use of City water and sewer service and any other rules and regulations which may be adopted by the City Council concerning said services. A deposit is required of owner and renters. If service is disconnected for non‐payment of the bill, there will be an added charge before reconnection can be made. All delinquent charges must be paid prior to any new applicant receiving water service. Copies of delinquency notices and shut‐off notices sent to renter are provided to property owner. Customer and/or property owner are required to maintain valid contact information and notify the City to schedule termination of service. Applicant’s Signature Date Co‐Applicant’s Signature Date SIGN SIGN ---PAGE BREAK--- CITY OF WOODBURN PUBLIC UTILITY SERVICE APPLICATION Building Permit Number Receipt Number Meter Deposit Number Date ADDRESS WHERE STRUCTURE AND / OR SERVICES ARE TO BE LOCATED Applicant/Owner Phone Number Service Type ☐ Single-Family ☐ Commercial ☐ Industrial ☐Multi-Family (Number of Units) ☐Other ☐MFD (In Park) Type and Size of Water Service Requested ☐Domestic Size ☐Irrigation Size ☐ Fire Sprinkler Size The applicant agrees to abide by all rules, regulations, ordinances, policies and specifications of the city relating to sewers, traffic, storm, water and parks as now exist and as hereafter are changed or amended. Signature of Applicant OFFICE USE ONLY Accepted and Approved by Date ☐Water Service Fee SDC Based on Meter Size Date Water Meter Installed Meter Deposit Domestic Meter # ID # SDC Charge Irrigation Meter # ID # Water Main Tap Fire Sprinkler Meter # ID # Installation Fee $ Sequence # Account # Meter Reading Manufacture Code ☐Sanitary Sewer Service Fee Residential Type ☐ per Dwelling Unit ☐ per Unit ☐per Bed SDC Charge SDC Based on Gallons Per Day (Peak Load) ☐Storm Sewer Service Fee Roof Area (sq. ft.) SDC Charge Concrete / Asphalt (sq. ft.) Tap Fee Total Impervious Surface (sq. ft.) ☐Traffic Impact Fee $ per unit, room, or other, multiplied by = Number of Units ☐Parks Fee Residential (All Housing Type) per unit, multiplied by units = Non-Residential per employee, multiplied by _________employees = 0 ---PAGE BREAK--- White Copy – File Yellow Copy – Water Department Pink Copy – Finance Department C:\Users\peggyki\Desktop\New Service Forms\WATER SERVICE FORM 4-2019REV.doc CITY OF WOODBURN PUBLIC WATER SERVICE APPLICATION Building Permit Number Receipt Number Meter Deposit Number Date ADDRESS WHERE STRUCTURE AND / OR SERVICES ARE TO BE LOCATED Applicant / Owner Phone Number Service Type Single-Family Commercial Industrial Multi-Family (Number of Units) Other MFD (In Park) Type and Size of Water Service Requested Domestic Size Irrigation Size Fire Sprinkler Size Signature of Applicant Sequence # Account # Meter Reading Week Route Date Water Meter Installed Domestic Meter # ID # Irrigation Meter # ID # Fire Sprinkler Meter # ID # ---PAGE BREAK--- City of Woodburn Building Department 270 Montgomery Street Woodburn, OR 97071 Phone: [PHONE REDACTED] [EMAIL REDACTED] SPECIAL INSPECTION AND TESTING To applicants of projects requiring Special Inspection or Testing as per Section 1704.1 of the Oregon Structural Specialty Code, please review the information below, acknowledge an understanding of the information by signing below, and return this form to the City. BEFORE A PERMIT CAN BE ISSUED: The Owner or their representative, on the advice of the responsible Project Engineer or Architect, shall complete, sign, and submit to this Department for review and approval, two copies of the this “Verification and Inspection Schedule”. The Owner and General Contractor, where applicable, shall also acknowledge the following conditions applicable to Special Inspection and/or Testing. 1. Contractor is responsible for proper notification to the Inspecting or Testing Agency for items listed. 2. Testing laboratory only should take samples and transport them to their laboratory. 3. Copies of all laboratory reports and inspections are to be sent directly to the City by the Testing Agency. All reports and correspondence shall contain permit, project title and project address. 4. Inspection Agency to submit names and qualifications of on-site Special Inspectors to the City for approval. 5. Special Inspectors shall provide appropriate reports to this Department of all inspection activity. 6. It is the responsibility of the Contractor to review City approved plans for additional inspection or testing requirements that may be noted. 7. BEFORE A CERTIFICATE OF OCCUPANCY PERMIT CAN BE ISSUED: The Inspection Agency shall submit a statement that all items requiring testing and inspection have been fulfilled and reported. Those items not tested and/or inspected shall be noted in this statement. Copy of statement to be maintained at the job site for City's Building Inspector’s review prior to final inspections. ACKNOWLEDGMENTS Owner Name (Printed) Owner Signature Project Engineer or Architect Firm Name (Printed) Project Engineer or Architect Firm Signature General Contractor Name (Printed) General Contractor Signature Testing Laboratory Name (Printed) Testing Laboratory Signature Special Inspection Agency Firm Name (Printed) Special Inspection Agency Signature Building Official Name (Printed) Building Official Signature Building Permit # Date Project Title Project Address SIGN SIGN SIGN SIGN SIGN SIGN ---PAGE BREAK--- [Type here] 5/18 TABLE 1705.2 REQUIRED VERIFICATION AND INSPECTION OF STEEL CONSTRUCTION VERIFICATION AND INSPECTION CONTINUOUS PERIODIC REFERENCED STANDARD CHECK HERE ⇓ 1. Material verification of high-strength bolts, nuts and washers: a. Identification markings to conform to ASTM standards specified in the approved construction documents. X AISC 360, Section A3.3 ASTM material standards b. Manufacturer’s certificate of compliance required. X 2. Inspection of high-strength bolting: a. Snug-tight joints. X AISC 360, Section M2.5 b. Pre-tensioned and slip-critical joints using turn-of-nut with match marking, twist-off bolt or direct tension indicator methods of installation. X c. Pre-tensioned and slip-critical joints using turn-of-nut without match marking or calibrated wrench methods of installation. X 3. Material verification of structural steel: a. For structural steel, identification markings to conform to AISC 360. X AISC 360, Section M5.5 b. For other steel, identification marking to conform to ASTM standards specified in the approved construction documents. X Applicable ASTM material standards c. Manufacturer’s certified mill test reports. X 4. Material verification of weld filler materials: a. Identification markings to conform to AWS specification in the approved construction documents. X AISC 360, Section A3.5 and applicable AWS A5 documents b. Manufacturer’s certificate of compliance required. X ― 5. Inspection of welding: a. Structural steel and cold-formed steel deck: AWS Dl.l 1) Complete and partial penetration groove welds. X 2) Multi-pass fillet welds. X 3) Single-pass fillet welds > 5/16” X 4) Plug and slot welds. X 5) Single-pass fillet welds ≤ 5/16” X 6) Floor and roof deck welds. X AWS D1.3 b. Reinforcing steel: AWS D1.4 ACI 318: Section 3.5.2 1) Verification of weld ability of reinforcing steel other than ASTM A 706. X 2) Reinforcing steel-resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X 3) Shear reinforcement. X 4) Other reinforcing steel. X 6. Inspection of steel frame joint details for compliance: a. Details such as bracing and stiffening. X b. Member locations. X c. Application of joint details at each connection. X ---PAGE BREAK--- TABLE 1705.3 REQUIRED VERIFICATION AND INSPECTION OF CONCRETE CONSTRUCTION VERIFICATION AND INSPECTION CONTINUOUS PERIODIC REFERENCED STANDARD IBC REFERENCE CHECK HERE ⇓ 1. Inspection of reinforcing steel, including pre-stressing tendons, and placement. X ACI 318: 3.5,7.1-7.7 1910.4 2. Inspection of reinforcing steel welding in accordance with Table 1705.2.2, Item 2b. AWS D1.4 ACI 318: 3.5.2 3. Inspection of anchors cast in concrete where allowable loads have been increased or where strength design is used. X ACI 318: 8.1.3, 21.1.8 1908.5, 1909.1 4. Inspection of anchors post- installed in hardened concrete members X ACI 318: 3.8.6, 8.1.3, 21.1.8 1909.1 5. Verifying use of required design mix. X ACI 318: Ch. 4, 5.2-5.4 1904.2.2, 1910.2, 1910.3 6. At the time fresh concrete is sampled to fabricate specimens for strength tests, perform slump and air content tests, and determine the temperature of the concrete. X ASTM C 172 ASTM C 31 ACI 318: 5.6, 5.8 1910.10 7. Inspection of concrete and shotcrete placement for proper application techniques. X ACI 318: 5.9, 5.10 1910.6, 1910.7, 1910.8 8. Inspection for maintenance of specified curing temperature and techniques. X ACI 318: 5.11-5.13 1910.9 9. Inspection of pre-stressed concrete: a. Application of pre-stressing forces. b. Grouting of bonded pre-stressing tendons in the seismic-force-resisting system. X X ACI 318: 18.20 ACI 318: 18.18.4 10. Erection of precast concrete members. X ACI 318: Ch.16 11. Verification of in-situ concrete strength, prior to stressing of tendons in post-tensioned concrete and prior to removal of shores and forms from beams and structural slabs. X ACI 318: 6.2 12. Inspect formwork for shape, location and dimensions of the concrete member being formed. X ACI 318: 6.1.1 a. Where applicable, .see also Section 1705.11, Special inspection for seismic resistance. b. Specific requirements for special inspection shall be included in the research report for the anchor issued by an approved source in accordance with ACI 355.2 or other qualification procedures. Where specific requirements are not provided, special inspection requirements shall be specified by the registered design professional and shall be approved by the building official prior to the commencement of the work. ---PAGE BREAK--- [Type here] 5/18 TABLE 1705.6 REQUIRED VERIFICATION AND INSPECTION OF SOILS CHECK VERIFICATION AND INSPECTION TASK CONTINUOUS DURING TASK LISTED PERIODICALLY DURING TASK LISTED HERE ⇓ 1. Verify materials below shallow foundations are adequate to achieve the design bearing capacity. X 2. Verify excavations are extended to proper depth and have reached proper material. X 3. Perform classification and testing of compacted fill materials. X 4. Verify use of proper materials, densities and lift thicknesses during placement and compaction of compacted fill. X 5. Prior to placement of compacted fill, observe subgrade and verify that site has been prepared properly. X TABLE 1705.7 REQUIRED VERIFICATION AND INSPECTION OF DRIVEN DEEP FOUNDATIONS ELEMENTS CHECK VERIFICATION AND INSPECTION TASK CONTINUOUS DURING TASK LISTED PERIODICALLY DURING TASK LISTED HERE ⇓ 1. Verify element materials, sizes and comply with the requirements. X 2. Determine capacities of test elements and conduct additional load tests, as required. X 3. Observe driving operations and maintain complete and accurate records for each element. X 4. Verify placement locations and plumb-ness, confirm type and size of hammer, record number of blows per foot of penetration, determine required penetrations to achieve design capacity, record tip and butt elevations and document any damage to foundation element. X 5. For steel elements, perform additional inspections in accordance with Section 1705.2. ― 6. For concrete elements and concrete-filled elements, perform additional inspections in accordance with Section 1705.3. ― 7. For specialty elements, perform additional inspections as determined by the registered design professional in responsible charge. ― ---PAGE BREAK--- TABLE 1705.8 REQUIRED VERIFICATION AND INSPECTION OF CAST-IN-PLACE DEEP FOUNDATION ELEMENTS CHECK HERE ⇓ VERIFICATION AND INSPECTION TASK CONTINUOUS DURING TASK LISTED PERIODICALLY DURING TASK LISTED 1. Observe drilling operations and maintain complete and accurate records for each element. X 2. Verify placement locations and plumb-ness, confirm element diameters, bell diameters (if applicable), embedment into bedrock (if applicable) and adequate end-bearing strata capacity. Record concrete or grout volumes. X 3. For concrete elements, perform additional inspections in accordance with Section 1705.3 ― ― FIREPROOFING: ⃞Placement ⃞Density tests ⃞Thickness tests ⃞Inspect batching (1705.13) MASTIC & INTUMESCENTS: ⃞Placement (1705.14) EXTERIOR INSULATION AND FINISH SYSTEMS (EIFS): ⃞Placement (1705.15) SMOKE CONTROL: ⃞Leakage testing ⃞Control verification (1705.17) WOOD CONSTRUCTION: ⃞Shear wall nailing ⃞Shear wall anchors ⃞Glulam fabrication psi (1705.5, 1705.5.1) ⃞I joist fabrication ⃞Sample and test components STEEL: ⃞Fabrication welding of steel accessories MASONRY CONSTRUCTION: ⃞Masonry construction shall be inspected and verified in accordance with TMS 402/ACI530/ASCE 5 and TMS $02/ACI530.1/ASCE 6 quality assurance program requirements. (1705.4) HELICAL PILE FOUNDATIONS: ⃞Special inspection shall be performed continuously during installation of helical pile foundations. (1705.8) ADDITIONAL INSTRUCTIONS, OTHER TEST, & INSPECTIONS: (IS THIS LIST CONTINUED ON AN ATTACHED SHEET? (Y / N) *PROVIDE STRENGTH REQUIRED BY ARCHITECT OR ENGINEER OR CONTRACT DOCUMENT LOCATION OF VALUES All inspections are continuous, unless specifically marked in the periodic inspection section and scope of work attached