Permit CITY OF TIGARD BUILDING PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: BUP2021-00260
Date Issued: 1/18/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons Food Stores 530 Subdivision: None Lot: None
Project Description: 3 new wall signs each weighing 65 lbs.
Contractor: YESCO LLC Owner: PACWEST ENERGY LLC
2401 FOOTHILL DR 3450 COMMERCIAL CT
SALT LAKE CITY, UT 84109 MERIDIAN, ID 83642
PHONE: 801-464-4600 PHONE:
FAX:
FEES
Specifics:
Description Date Amount
Type of Use: COM 11/15/2021 $256.22
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations,
Occupancy Grp: U OccupancyLoad: 0 Demolition
p y 12%State Surcharge-Building 11/15/2021 $30.75
Dwelling Units: 0 Plan Review 10/27/2021 $166.54
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 11/15/2021 $1.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $11,378
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $455.01
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
t^Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
.
Building Permit Applicati ECEtVED .
Commercial OCT 21 2021 IY)It 01.1 It' I, I .SI ()Nl 'i
City of Tigard ITY OF TIGARU Datei3,�/q 402/ 'i Permit Ne. 'fP2o' -Q� i0
13125 SW hall Blvd.,Tigard,OR 9722�d1n ^ Plan RcvicN (�
� s Phone: 503-718-2439 Fax: 503-59$�VTLDING DIVISION Date/Bv: I J' I��� Related Permit:
1 I l,.A it 1, Inspection Line: 503-639-4175 Date Ready/By: a /,...; Junk E See Page 2 for
Internet: www.tigard-or.gov N ed/Method:I Ai, /i Supplemental Information
l
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
0 Addition/alteration/replacement Other: r_. equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
/�Job site address: A 9d 1 /iA New dwelling area: square feet
City/State/ZiP: `'�;`-„4) Qi� Z/a►7a 4 Garage/carport area: square feet
Suite/bldg./apt.#: "'(1�" Project name:Lpc-k a Covered porch area: square feet
______�
Cross street/directions to job site: gui Q Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 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.
3 /9 kd_ .0 4 Valuation: $ !!f 5 71r
SI3S (6��gS -Q.AcN _________.__.. Existing building area: square feet
Cyr N (. New building area: square feet
PROPERTY OWNER 0 TENANT Number of stories:
Name: Tit t sons Val.( L rile-+ SII LL Type of construction: —
Address: ,SL>.g'.-_earning,"___l (:F --_.-----.----__--,—. Occupancy groups:
City/State/ZIP:014/14n , _'v 4 2- Existing:isting: m
Phone:(4) zee- gspe Fax:( ) New:
y1.44.PPLICANT CONTACT PERSON BUILDING PERMIT FEES* 1
Business name: .y�,� (Please refer to fee schedule)
"T t' = Structural plan review fee(or deposit):
MUM:
: I ci I maiL� ,
FLS plan review fee(if applicable):
Address: 4(6 a 414.f.
City/State/ZiP: ,„I Z7::, 17 Total fees due upon application:
1:04,Phone:006)QD 8- Y Fax::( ) Amount received:
fi �,ytat 4��.Yew.�t PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
�y� CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ' rQ,�Q L�� Submit two(2)sets of roof plan with connection details
�.1} and fire department access,along with the 2010 Oregon
Address: 414 Solar Installation Specialty Code checklist.
City/State/ZIP: ats� x� 4351/4 Permit fee(includes plan review $180.00
/ and administrative fees):
Phone:goo 9,00_ 47 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.. , Total fee due upon application: $201.60
Authorized signature: t This permit application expires if a permit is not obtained
tag, within 180 days after it has been accepted as complete.
Print name: ‘ f I 'AS
Date: * Fee methodology set by Tri-County Building industry
t 4 Kt' /MAt.�._---....--_-..__ 1d'�� Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-46I3T(11/02/COM/WEB)