Permit Support Document V 9 / I go
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT "l fer W.
IIIa
Request for Permit Action RECEIVED
TIGARD 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov
SEP c! NE1
TO: CITY OF TIGARD CITY OF TIGARD
Building Division BUILDING DIVISION
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner Applicant El Contractor El City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Strikeforce Design
Mailing Address: 4 8 3 6 NE 3 7 th Ave
City/State/Zip: Portland OR 97211
Phone No.: 971 270 0951
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
6 ❑ CANCEL/VOID PERMIT APPLICATION.
(o _^ C REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
r c)ri` ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: MST2020-00184 - 9920
Site Address or Parcel#: 9920 SW View Terrace
Project Name: Zarrabi Renovation
Subdivision Name: Ingebrand Terrace Hights I.ot#: 2101-9
EXPLANATION: Project did not move forward; if refund is unavailable
that i s romp] et el y a_nderstoot..__
Signature: S / Date: 9/9/21
Print Name: Sarah Steinbe
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 S s Admin: Date tiMINIM`-, Route to Records: Date 1.2172-" By_ /
Refund Processed: Date L By /0 Invoice Processed: Date By
Permit Canceled: Date '////2.." By 4 C Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120518.doc
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Residential -. ,
City of Ti I )k ( ,l I I, F I ,1 lied 1
Received ,-- .1W Hall Blvd.,Ti °sue : r Alf...if Permit No.: ,-
Bard,OR 97223 j..4 13125 S Phone: Pier Revives Y .,,., -s. iL
S03.718.2439 Fax: 503.598.1960 natol
I I(,nit I) Inspeetian Line: 503.639.417E Due> �>r Other �
Intoner www-tigard•ar.gov Nodded/Method; r'n" 0 so,Inp 11b►
; a _Ruppleeneaqd Idonuvtbm
1 TYPE OF WORK
REQUIRED DATA:I-AND 2.VAMIt.Y DWELLING
G
0 New construction _
❑Demolition Permit fees*are based on the value of the work performed.
(3 Additian/alteragaNraplaoamout CI Duller Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY Op( NSTRUC1'ION work indicated on this application.
1 El 1-and 2-fluntly dwelling ❑Commercial/industrial Valuation: $ 40, 000
1 0 Accessory building
0 Muni-ilmtily Number of bedrooms: 6
0 Master builder
k .._.... Number of bathrooms: 3 . 5
JOII strr INFORMATION AND LOCATION Total number of floors: 2 @ 16 8 0 s f
i Job site address: 992 0 SW View Terrace r-
Now dwelling area 0 square feet
city/statatP; Tigard, 4R 97224
Garesecarpart war 5 2 0 square feet
1 suite/bidg,/itpt.no mace, Zarrabi�__Renovation
.�._ �_ Covered porch area: 0 square foal
directions to*site;
SW 100th and SW View Terrace __ square feet
Rack area 4 6 0
Other structure area: square
f
ed
REQUIRED DATA:CONKER-
ERGIALVSE ,D'1,
Subdivision: Ingebraad Terrace Heights i Lot no,:2101-9 Permit fees t are bared on the value of the work performed.
Tax map/parcel no.: 2SiT1EA021-01 i ..__.- -_ Indicate the value(rounded to the nearest dollar)of all
11.1 — — ___ equipment,materials.labor,overhead,and the profit for the
TION or WORK work indicated on this application.
v Interior renovation reconfig
ures basement and Valuation: _
main floor to add one bedroom and 1/2 bath Existing build area: f
_ -1�- _ ._,.__._ __ ___.�_ ._._ square feet
`"Qr' 1 L4. (k , 5' , j i-. New building area: square feet
af PROPERTY ®Whlllfl `
M Ol{� GtV k k S motwl orr IZl Number of stories:
Name.
b J Type of
14 4 �Y
Atldrss __`f?4b WWId_ _._. _ :
City t /ZIPJr Y l _ - _.
v 7 5 4 `�-- Existing:
`�, Phone;(Zip) 3sr - ` �z3 F ( )
kti — (3;APPGICAItT CONTACT N RVII.DIPK FERiliii PEES __ - ._..
I,, Business name: Btrikefores Design _ mow, rw roscro r,1
______ __ __ __ �___.__.._.-._.__ Structure!plan review fee(or deposit):
: Contact name; Sarah Steinberg . _
___ _
FLS plan review fee(if applicable):
Address. 4836 NE 37th Ave
Total foe duo
City/State/ZIP; Port�,aad OA 7 211 upon application:
Pbano.(971) 270 0951 lFwc ;( )
Amami received:
5:nail.—dash@strikeiorcedesign.net ��xrovoiTAIcSca. liram.s FEES*
Commercial and residential
__--- prescriptive of
CONTRACTOR
roof-top mourned PfmtoVoltaie Solar Panel System.
Bus' ' '''' •u E L I NG L L C Submit two(2)sots of roof plan with connection details
22
00 - - s and fire department access,along with the 2010 Dragon
Solar Installation Salr_y Code checklist.
City/State/ZIP; Hillsboro OR Pewit Fee(includes plan review
Phone:( 50 -888-7261clitammimi and watbos): $Ig0.00
applicatiam
Surto surcharge(12%of
CCU lie.:
206062
permit he): S21.b0
_
r._ _____ _.- — __ Total fee duo open $201.60
Atttbarind sigaapue.;. 4/Z u This permit application a
pM expires if a permit ix not-Obtained
within 180 days alter It has been accepted as complete.
A r Date: 2)1
'Foe methodology sot by Tri•County Building Industry
Arlt!< � Service Board.
1:WuildnglwermitsWUP•RESPonnitApp.doc 02/24/2011 440.4613T(11/02/COM/W5B)