Permit ACS ELECTRIC, LLC
19325 Edy Road
Sherwood, Oregon
97140
503- 625 -1862
Protecting Tomorrows Futures Today
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RECEIVED
e . ° Building Division c E �,
r ► c. is a Request for Permit Action CITY OF TI _ ■ �
1 1G DIV /SION
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fan: 503.598.1960 www.tigard- or.gov
PROM: ❑ Owner Applicant )6 Contractor ❑ City Staff
(cheek one)
REFUND Name: �� /�� / i C---- / / e.
INVOIC T : (Business or 1rt�viduaq 1 y'' r 4 L
V 0 1 Mailing Address /93? , sue) /y 2A-CI
Q • pt' oa,,-%)/ City /State /Zip: 1i ' . :vv. a t 0
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/ Phone No.: 5b3 ( 1y2 35 0e, say - S X8'
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED C ���
4 CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt; if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). � O
Permit #: 4 ' 2Z) Ooc�y6 ) 0 FS ,
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Site Address or Parcel #: 1285 6c0 r .v+ Ave. / c rdl r o
Project Nance: 13A4 77e '"e- 00
Subdivision Name: 6 Lot #:
EXPLANATION: g Na ; rc({ (Z) Pre I4r / i >
Oita 3 (.7-1 �� - 44il Tri ,Pi' -,',..,4 .Aar -e 0 4.e44 pd,
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Signature: ��« Date: - a •4l.
Print Name: ,6e '7 t-s f
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1. The Director or Building 0ffieiel may authorize the refund of
a) any fee which was erroneously paid or collected
b) not more than 8074 of the land use application fee when an application is withdrawn or canceled before any mew c foe has been expended
c) nor more than 50% of the land use appliestion fee for issued pewit!.
c) not more than BO% of the building plan .review fee whom an application is canceled before any plan review effort has been expended
d) not more than 8014 of the !wilding permit fee foe issued ?conks prior to any inspection requests.
2 Rehmds will be returned to the odg ual Payer in the sane method in which payment was received. Please aflo+r 1.2 weeks for processing refunds.
I OR OF L'cr -. ONL\
Rte to S : Admit!: Date B Rte to Bid Admire Date / ..
Refund Processed: Date 9/7/0...f- , By :'� .� Invoice Processed: Date • / By .
Permit Canceled: Date i j0 k B •/ -. Parcel Tag Added Date By
Receipt # Date Method CIv Amount $ ,
I: \Building \Forms \ReePerrnitActien.doe Rev 05/24/06
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- 2'd 096T86S20S:01 298TS2920S 0110Ii'I10313-SJd:W0219 d6T:90 t,002- 172 -AdW
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Building Permit Applicati 1 � �'jI v ,�n
C ommercial , 7 °i —�..' Ilfi 1h � iR OF;L ��, , ,,,,, lk atl M - , A la:;
0 /, . I f� , ' D Received
� `� 'aaM I r 31� { FOR O F FP CE, USE O LY Q i y ,_ J
City of Ti rd ,
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ty . I - r � � �° � Date/B � _ � •' I j,, Permit No '� , � � ,
13125 SW Hall Blvd., Tigard, OR 972 %4 Z� ,.. -' '' �C ' plan Review
' C Phone: 503.639.4171 Fax: 503.598.19: I `- ' @ Other Permit:
T I GA R t� Inspection Line: 503.639.4175 04 At''' eady /By: Juris. ® See Page 2 for
g g '' . i te d/Method: Ur, , Supplemental Information
G Internet: www.ti ard -or. ov ® � ® % , 01 4 :ii,
TYPE OF WO RK � ®� REQUIRED DATA: 1 -AND 2- FAMILY DWELLING
❑ New construction ❑ Demon Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
/ 01Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: y9 a5--0 �.J2 r .. G „ A New dwelling area: square feet
City /State /ZIP: 7 * o / '7'023 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: g / .1t Covered porch area: square feet
Cross street/directions to job site: (� Deck area: square feet
Other structure area: square feet
:REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 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.
�/ ^ i � f / (cc i / ✓ Valuation: $/ �j/)
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: 51—o 4.0/.1,4-y •.5f' 7 4 g mitor I y . Type of construction:
Address: /Z � ' 0 .3 � evr... -1- � M
, L r ” Occupancy groups:
City/State/ZIP: / [ re ) c 72- 3 Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: �, ��eG ! �c_ All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax: : ( )
E -mail:
CONTRACT R. .
Business name: 2 "5 /�C.,t L e BUILDING PERMIT FEES*
::e/z � , ` � ?40 IP: sties ✓��` � 9 7/C f O Structural plan review fee (or deposit): i 3 . uk3
Phone: ( 9:f 62-.5- - /g6 Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application: t7 �3 .
j +/ ICJ
Tom" _ Mt Amount received:
Authorized signature: './ i� �� `�.
f . This permit application expires if a permit is not obtained
�� within 180 days after it has been accepted as complete.
Print name: a ; � , . i Date: , o � * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB)
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Building .Division
Accessibility: Barrier Removal Improvement Plan
T 1GARD
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 per -cent (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): $
•
1:\ Building \Permits \BUP -COM PermitApp.doc 10/30/07
Building Division
Plan Submittal Requirements
T 1 G A R D, Commercial & Multi- Family - New, Additions or Alterations
1. SITE PLAN (fully dimensional, drawn to scale) labeled with:
A. ❑ map & tax lot # ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ 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.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
I:\ Building \Permits \BUP -COM PcrmitApp.doc 10/30/07
:z.
Building Division
Plan Submittal Requirement Matrix
T 1 G A k D`' Commercial & Multi- Family - New, Additions or Alterations
Type of Submittal # of Plans
(Includes new, additions. and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 2*
Fire Protection System 2 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
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)
* For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
I: \Buildin \Permits \BUP -CONI PermitApp.doc 10/30/07
City of Tigard, Oregon e 13125 SW Hall Blvd. Tigard, OR 97223 <34* r���kr- . .
,� „: 747
August 29, 2008
at¢'
RE: FIRE ALARM
ull ARD
Building Permit: BUP2008 -00282 Construction Type: 5 -A
Tenant Name: Broadway Rose Occupancy Type: A -1
Address: 12850 SW Grant St. Occupant Load: 641
Area: N/A Stories: 2
The plan review was performed under the State of Oregon Structural Specialty Code
(OSSC), 2007 edition; the Oregon Fire Code (OFC), 2007 edition and NFPA 72 Alarm
Code.
1) There is a existing permit that covers the same alarm system as this permit.
Please clarify which permit will be used for construction prior to my plan
review approval for this permit.
2) Please show how compliance with the requirement for smoke and heat
venting is tied into alarm system permit. (OSSC 410.3.7.1&2)
When responding, provide an itemized letter stating in what way each numbered
issue has been addressed in the revision.
When submitting revised drawings or additional information, please attach a copy of the
enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City
of Tigard in tracking and processing the documents.
Respectfully,
4110.,/
Irore-
Dan Nelson,
Senior Plans Examiner
(503)718 -2436
dann c@tigard- or.gov
Phone: 503.639.4171 o Fax: 503.684.7297 ® www.tigard- or.gov ® TTY Relay: 503.684.2772
• City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
111
•
T I GARD
October 7, 2008
ACS Electric LLC
19325 SW Edy Rd.
Sherwood, OR 97140
Attn: Robert West
Re: Permit No. ELR2008 -00246 and BUP2008 -00282
Dear Mr. West:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12850 SW Grant Ave.
Project Name: Broadway Rose Theatre Co.
Job No.: N/A
Refund: ® Check #59672 in the amount of $240.86.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as general contractor hired two electrical contractors and one
set of plans was approved prior to plan review of this permit. Refund 80% of permit fees
and 100% of plan review.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds\ Administration \UrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772
City of Tigard
TI CARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: ACS Electric LLC DATE: 9/17/08
19325 SW Edy Rd.
Sherwood, OR 97140 REQUESTED BY: Dianna Howse
Attn: Robert West
TRANSACTION INFORMATION:
Receipt #: 2008 -2957 Case #: ELR2008 -00246 and
BUP2008 -00282
Date: 8/20/08 Address /Parcel: 12850 SW Grant Ave.
Pay Method: Check Project Name: Broadway Rose Theatre Co.
EXPLANATION: Two contractors hired by general contractor; one set of plans already approved prior to
plan review of these plans. Refund 80% of all permit fees & 100% of plan review.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. • Refund •
Example: [BUILD] Permit Fee • Example:. 245- 0000 - 432000 $ Amount
[ELPRMT] ELR Permit 220 - 0000 - 431510 $60.00
[TAX] 12% State Surcharge 100- 0000 - 207020 7.20
[BUILD] Permit Fee 245- 0000 - 432000 107.20
[TAX] 12% State Surcharge 100- 0000 - 207020 12.86
[FLS] FLS Pln Rv 245- 0000 - 433020 53.60
TOTAL REFUND: $240.86
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager ' ��
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
V • FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I 9` / /7 /Cf V I By: I 457r
I:\ Building\ Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 820,2008 •
4
13125 Sys' Hall QI\d. 4:44:54PM
Tigard, OR 97223 503.639.4171
TIGARD
n.
Receipt #: 27200800000000002957
Date: 08/20/2008 cr
R
. Line Items:
Case No Tran Code Description Revenue Account No Amount Paid -
ELR2008 -00246 [ELPRMT] ELR Permit 220- 0000 - 431510 75.00 3
ELR2008 -00246 [TAX] 12 State Surcharge 100- 0000 - 207020 9.00 D
BUP2008 -00282 [BUILD] Permit Fee 245- 0000 - 432000 134.00 m
BUP2008 -00282 [TAX] 12% State Surcharge 100- 0000 - 207020 16.08
BUP2008 -00282 [FLS] FLS Pln Rs• 245- 0000- 433020 53.60
Line Item Total: S287.68
Payments:
Method Paser User ID Acct. /Check No. Approval No. How Received Amount Paid
01
Check ACS ELECTRIC, LLC. BTT 2225 In Person 287.68 m
m
Payment Total: S287.68 ru
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