Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
4
I Request for Permit Action a
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • «ww.tigard- 41.7.4
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):
IR 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).
Permit #: 04' /—0000/
Site Address or Parcel#: /o/1/5— aW tyre' 1- /Eri.
Project Name: /¢"4124/►"4.
Subdivision Name: Lot #:
EXPLANATION: /J to keyn j f I0(/At f j,,,
o(e- * -5. a - 7
reV, 4w 1 !-; i4 &f b-e
l-nwj-r ig./ 1riw" Af,20a- —ocklr)1 7 /U/91M-vco74.
Signature: /� r Date: ,345`/al
Print Name: �v(� 77-
reg-
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date 3,jc /r By Route to Records: Date c. .7 By 4 �)
-R€ t l Processed: Date '(/�jZ/Z/ By { Invoice Processed: Date By
Permit Canceled: Date p/2/l/ By 0 Parcel Tag Added: Date By
I:\Building\Forms\RegPemutAction_12 51 ..doc
Building Permit Application ° / 4+ . _ 2
Commerclalui FOR OFFICE USE ONLY
ECEIVEIJ
City of Tigard Received
a«B a O � / Permit No.:j P202./-0000
1111 - If Phone:
SW Hall Blvd.,Tigard,OR 97223 DEC 2 4 2020 Plan Review
Phone: 503-718-2439 Fax: 503-598-1960 Date/By: /��-pv "illRelated Permit:
T I GARD Inspection Line: 503-639-4175 Date Ready/By: J ® See Page 2 for
s Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: \ I Supplemental Information
BUILDING DIVISION �i
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
1g]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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
' ❑ 1-and 2-family dwelling LK Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16145 SW Upper Boones Ferry Rd New dwelling area: square feet
City/State/ZIP: Tigard/OR/97224 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Kiddie Academy-Tigard Covered porch area: square feet
Cross street/directions to job site: SW Upper Boones Ferry Rd Deck area: square feet
{) Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: 00701 Permit fees*are based on the value of the work performed.
Ci%
Tax map/parcel#: 2S113AB00701 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on tls, liapp cation.Jd,a the ro 7or he
New 10,861 SF daycare facility with parking lot and play areas. Valuation: $ , gTppOqit
Existing building area: n/a square feet
New building area: 10,861 square feet
PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Kalvi LLC Type of construction: VB
Address: 8821 NW Savoy Ln. Occupancy groups: E
City/State/ZIP: Portland/OR/97229 Existing: n/a
Phone:(503 )577-3822 Fax:( ) New: n/a
❑ APPLICANT igl CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: CIDA Inc. Structural plan review fee(or deposit):
Contact name: Gavin Russell
FLS plan review fee(if applicable):
Address: 15895 SW 72nd Ave., Suite 200
City/State/ZIP: Portland/OR/97224 Total fees due upon application:
Phone:(503)226-1285 Fax: :( ) Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: gavinr@cidainc.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: TBD Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
I CCB Lie.:
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Gavin Russell Date: 12/22/2020 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(I 1/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
II 114 Accessibility: Barrier Removal Improvement Plan
I
Commercial & Multi-Family - Additions or Alterations
I I G A It a 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
REQUIREMENT: OREGON REVISED STATUTE (ORS)447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five percent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section,priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
•
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
!Pi " Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
TIGARU 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with:
A. El map&tax lot# El project name ❑ site address ❑ suite number
❑ zoning El applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit- based on valuation of project.
L\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
" Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan is required showing location and square footage
of all buildings to be demolished,erosion control plan and
tree protection,if applicable)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Solar Photovoltaic 2
(Requires check list for prescriptive installation. If not
prescriptive installation,engineering is required.)
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,Washington
County, and Tualatin Valley Fire &Rescue), if applicable.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/(15/2019