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HomeMy WebLinkAboutBUP2022-00306 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Re quest for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov 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 N City Staff Check(✓)one REFUND OR Name: �" INVOICE TO: (Business or Individual) jam 1 7I45 't" 0trer]0 ram) — )c y^Y. 14 t*t i- " Mailing Address: 7o e ie 65 l City/State/Zip: t,t L,,,ca) D 0l7 G PhoneNo.: q7 ( - 772-7C65-- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 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#: (4...p y0)-A.- 00 j0c. Site Address or Parcel #: (t,) ©J cj irt/ Pa c i 1 Project Name: al ,p v11P Ati-e. A s C ci--1•••1 6,,t` /[ Subdivision Name: Lot#: EXPLANATION: V ct.,(4 t Yz ' r'('s.si c 1- A rt` 1/1e d 1.' et ' pe.V"v�I,-� r *rNI4 ,V Signature: �--i%� ---- Date: Lail'' 4-d- . Print Name: ___)0c:- 43;1. `L 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 Sys Admin: Date By Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date1Z•�12n By Parcel Tag Added: Date $ I:\Building\Forms\RegPernutAction 20518.doc y Building Permit Application Commercial RECEIVED l t>lz tll El( E l S1 OM 1 City of Tigard Receivedriffillien 13125 SW Hall Blvd.,Tigard,OR 97223 DEC 0 7 2022 DateB : t 7-� T$ � i Phone: 503-718-2439 Fax: 503-598-1960 Plan Review Date/B : Related Permit: T 1 v n K I) Inspection Line: 503-639-4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORKREQUIRED DATA:1-ANI)2-FAMILY DWELLING 0 New construction ❑D molition Permit fees*are based on the value of the work performed. ❑Addition/alteration/replacement m: NiIndicate the value(rounded to the nearest dollar)of all c l it j equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONST'1C,UCTION ` work indicated on this application. ❑ 1-and 2-family dwelling ommercial/industrial Valuation: $ ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITEINFORMATION AND LOCATION Total number of floors: Job site address: 1 (p- _� S W � n U c New dwelling area: square feet ( 1it-LAJ‘q City/State/ZIP: ' Garage/carport area: �`�' ' �� � —1 � 2�.�-� square feet Suite/bldg./apt.#: 31 Project name: t_I t 1 f' � Covered porch area: square feet Cross street/directions to job site: jj'" S - Deck area: square feet w1 PAD-' - Other structure area: square feet REQUIREDDATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: v��S n 0 ,f /�16' Indicate the value(rounded to the nearest dollar)of all +D �LJ -L JCJ KJ equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. * ( I l l t"D i(Q l•1 T1-U l C-C� U S i( .A) Valuation: $ ` � I G € E C c� Existing building area: 1 square feet New building area: square feet PROPERTY,OWNER" 0 TENANT` Number of stories: Name: -,,,�� I i 1 t�►2._. tp,:vvt_apt-- DE-f Type of construction: s 1 ��Address: 1 1-2l C� �r . Occupancy groups: City/State/ZIP: Phone:( � �^, C�O j � Existing: Fax: � New: RN/APPLICANT L CONTACT PERSON BUILDING PERIV S*. Business name:±-,-,jr. .6,,g_trt, �w (.)i ..Contact name: , 1\;� —�.__,�) Structural plan review fee(or deposit): Address: `�D R �x F-"' ram" FLS plan review fee(if applicable): City/State/ZIP4 $ o /y2 G 6 3 Total fees due upon application: Phone:�'"7y '�"7 Z* `� /_�(�v J Fax:_:!( ) Amount received: E-mail: Uc {{Vat.1�t„oa�,l � Q rep . c- PHOTOVOLTAIC SOLAR PANEL SYSTEM l l * NTRA Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: � �i� S16,,,u n r Submit two(2)sets of roof plan with connection details Address: ,-...?0, �� and fire department access,along with the 2010 Oregon C Solar Installation Specialty Code checklist. City/State/ZIP: g i) q C)3 Z Permit fee(includes plan review 9S 1 3-7 4 I Fax:( ) and administrative fees): $180.00 Phone: I p CCB Lic.: 19 Li j State surcharge(12%of permit fee): $21.60 Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not L I Vobtained �..�, t within 180 days after it has been accepted as complete. I print name: V 0 j-1 Trj ILEA__ I Date: t I * Fee methodology set by Tri-County Building Industry t` 'r_ )2,q)z_z_ Service Board. I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-461 3T(11/02/COM/WEB)