Permit CITY OF TIGARD BUILDING PERMIT
• Ilt COMMUNITY DEVELOPMENT Permit#: BUP2021-00237
Date Issued: 11/18/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons No.530 Subdivision: None Lot: None
Project Description: Demolition of existing 839 sq ft car wash, 1114 sq ft convenience store,and 4355 sq ft fuel canopy. UPON FINAL
INSPECTION, DEMO CREDITS FOR PARKS,TRANSPORTATION,AND SEWER SDC FEES WILL APPLY.
Contractor: ONSITE DEVELOPMENT Owner: PACWEST ENERGY LLC
PO BOX 3171 3450 COMMERCIAL CT
OGDEN, UT 84404 MERIDIAN, ID 83642
PHONE: 801-621-1600 PHONE: 208-888-6061
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: DEM T DC Provision Review,COM TI-Ping 11/17/2021 $110.00
ype of Const:
Occupancy Grp: Occupancy Load: Permit Fee-Additions,Alterations, 11/17/2021 $872.52
Dwelling Units: 0 Demolition
Info Process/Archiving-Sm$0.50(up to 11/17/2021 $0.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0 Erosion Control w/Development 11/17/2021 $161 40
Value: $68,950
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,144.42
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1,800,332.2344
Issued By: Ho-UAj Va.w De,Wegi: Permittee Signature: Ow AYyr u,c4'
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.
Building Permit Applicatio ECEIVED
Commercial OCT - 1 2021 FOR OFFICE
,yUU�S`E��ONLY
City of Tigard ReceivedPr
//Q/f eZ/ /�/ It bt' 9001/037
P17Y OF TIGARD
13125 SW Hall Blvd.,Tigard,OR 972 Plan Review /
Phone: 503-718-2439 Fax: 503-5 1 Date/By: Related Permit:
l�l�°DING DIVISIOn�
TIGARD Inspection Line: 503-639-4175 Date Ready/By: / Juris Pi See Page 2 for
Internet: www.tigard-or.gov hPotified Method: 5 / /I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑x 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:
CI I-and 2-family dwelling ❑x Commercial/industrial
$
IDAccessory building CI Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11290 SW Bull Mountain Road New dwelling area: square feet
City/State/ZIP: Tigard,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Jacksons No.530 Covered porch area: square feet
Cross street/directions to job site: Northwest corner of intersection of SW Bull Mountain Road Deck area: square feet
and SW Pacific Highway Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I.ot#: Permit fees°are based on the value of the work performed.
Tax map/parcel#: 2S1 10AC01101 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 this application.
Demolition of existing car wash;c-store and fuel canopy Valuation: $ 68,950
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacWest Energy,LLC Type of construction:
Address: 3450 East Commercial Court Occupancy groups:
City/State/ZIP: Meridian,ID 83642 Existing:
Phone:(208)) 888-6061 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Barghausen Consulting Enginners,Inc.
Structural plan review fee(or deposit).
Contact name: Caryl Pinner
FLS plan review fee(if applicable):
Address: 18215 72nd Avenue South
Total fees due upon application:
City/State/ZIP: Kent,Washington 98032
Phone:(425 ) 656-1063 Fax::( ) Amount received:
E-mail: cpinner@barghausen.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ONSITE DEVELOPMENT INC. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: P O BOX 3171 Solar Installation Specially Code checklist.
City/State/ZIP: OGDEN,UT 84404 Permit fee(includes plan review $180.00
and administrative fees):
Phone:( 801)425-9038 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 216265 exp.07/17/2023
Total fee due upon application: $201.60
Authorized signature: C " L----- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Caryl Pinner Date: September 30,2021 * Fee methodology set by Tri-County Building Industry
Service Board.
L\Building\Permits\BHP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(I 1/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I c R D Building Permit Review — Commercial - With Land Use
Building Permit #: 2,0P2.o21- 0023-1
Site Address: 11290 SW Bull Mountain Road Suite/Bldg#:
Project Name: Jacksons No. 530
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Demo structures on site
Verify site address/suite# exists and active in permit system.
® River Terrace Neighborhood: ❑ Yes ❑ No
IN Land Use Case#: CUP2017-00005
I Plans Match Approved Land Use:
Site Plan MaLandscape Plan ❑ Other:
Ina Urban Forestry Plan naElevation Plan
IP Building Height: Maximum Height Actual Height
RI Conditions Met: ® Prior to Submittal ® Prior to Permit Issuance
Business License:
Exists: ❑ Yes E No,applicant was provided a business license application
® Public Facilities Improvement (PFI) Permit: PF12018-00289
Required: gi Yes, applicant was notified € ❑ No Applied For: ® Yes ❑ No, stop intake
Notes: ' M ()meal(M
Approved by Planning: Date: I t 112D2A
I
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: (j
� l
Site Plans: # 3
Building Plans: # --
Building Permit#: ,0'Enter building permit# above.
Workflow Routing: Planning .Engineering ❑ Permit Coordinator ❑ Building
Workflow Sign-off: 'Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: /v// /2/
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Engineering Review
Slope at building pad: f
❑ PFI Permit#: I'J
.Conditions "Met"prior to issuance of building permit
E 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 l No
Assess Water Quantity Fee in-lieu: ❑ Yes [ No
LIDA Facility on lot: ❑ Yes H'flo
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: K . fl S 14 E Date: /e — b-Zazl
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ 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:
Revision Notice 3: Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ,/ N/A
Tigard Trans SDC: ❑ Yes 'N/A
�/ Parks SDC: ❑ Yes / N/A
j% OK to Issue Permit
/Approved by Permit Coordinator: l7L Date: tt \ \242/(
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