Permit t ` 'i q CITY ,OF O P T I BUILDING PERMIT
CO M M UNITY DEVELOPMENT DATE #: B /11/20 -00627
E ISSUED: 12/11/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S135BD -00100
SITE ADDRESS: 09600 SW OAK ST 28'6,23V ZONING: C -P
SUBDIVISION: PLAZA WEST LOT: 005 JURISDICTION: TIG
PROJECT: BLDG. CONFERENCE ROOM
Project Description: TI
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 37 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: Y PARKING:
VALUE: $ 8,500.00
Owner: Contractor:
ASA PROPERTIES, INC CG CONSTRUCTION
BY PAUL DEVILLE 1801 NW UPSHUR ST
PO BOX 3110 SUITE 400
HONOLULU, HI 96802 PORTLAND, OR 97209
Contact #: PRI 503 - 226 -1078
Phone: FAX 503 - 226 -1088
Reg #: LIC 1156
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
(BUILD] Permit Fee 12/11/2007 $112.55
[TAX] 8% State Surcha 12/11/2007 $9.00
IBUPPLN] Pln Rv 12/11/2007 $73.16
[FLS] FLS Pln Rv 12/11/2007 $45.02
Total $239.73
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 than 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 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By j®- / ,, j Permittee Signature: X _AZ-C-7 -s,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Application Y , . °
� l FOR OFFICE lc I usr c��i �
! Received
a City of Tigard 1h1ne SW Hall `r 1,,® Date/B : _ 1 ± 1 $ PermitNo.: g 1 —O 2 '/
. ` g• !Y Plan Review ►1 ��
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : ` 'j Other Permit:
1
TI G A R D Inspection Line: 503.639.41 r . 001 Date Ready /By: huts: : ® See Attached Checklist for
Internet: www.tigard- or.govUl (. Notified/Method: Supplemental Information
UITY OF rIGARD
. ° in! /Wow* - REQUIRED DATA: 1- AND 2- FAMILY DWELLING
• ❑ New construction ❑ 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.
El 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: 9600 SW Oak Street New dwelling area: square feet
City /State /ZIP: Tigard, Oregon 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.,‹A lo Project name: Bldg Conference Room Covered porch area: square feet
Cross street/directions to job site: SW Oak and Greenburg Road at Hwy 217 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.
Tenant improvement build - out for a shared building common conference room Valuation: $$8,500.00
Existing building area: -- square feet
New building area: 558 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 5
Name: Plaza West LLC Type of construction: 2 B
Address: c/o NorrisBeggs &Simpson / 121 SW Morrison, Ste 200 Occupancy groups:
City /State /ZIP: Poertland, Oregon97209 Existing: B
Phone: (503)223 -7181 Fax: (503)273 -0256 New: B
®' APPLICANT ❑ CONTACT - PERSON' NOTICE
Business name: GBD Architects Incorporated All contractors and subcontractors are required to be
Contact name: Ray R. Glur licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 NW Couch Street, Suite 300 jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, Oregpn 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9656 Fax: : (503) 299-6273
E - mail: ray @gbdarchitects.com
. .CONTRACTOR.
Business name: CG Construction BUILDING PERMIT FEES* • '
Address: 1801 NW Upshure Street, Suite 490 ' (Please refer to fee schedule . .
City /State /ZIP: Portland, Oregpn 97209 Structural plan review fee (or deposit): f
Phone: (503) 226 - 1078 I Fax: (50 - 3) 226 - 1088 FLS plan review fee (if applicable):
CCB lie.: 1156 Total fees due upon application:
Amount received: A541 .7
Authorized signature: �„ - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Ray R. Glur I Date: 12/11/2007 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \ Permits \BUP•PermrtApp.doc 03 /21/06 440- 4613T(11/02 /COM/WEB)
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
• . . .
T I GARD
July 2, 2008
GBD Architects, Inc.
1120 NW Couch St., Ste. 300
Portland, OR 97209
Attn: Ray Glur
Re: Permit No. BUP2007 -00627
Dear Mr. Glur:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9600 SW Oak St.
Project Name: Conference Room
Job No.:
Refund: ® Check #58051 in the amount of $97.24.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as scope of work changed and the work is being done under
another permit. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
•
I: \Building\ Refunds \Administ ration \LaRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
TIGARD 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: GBD Architects, Inc. DATE: 6/25/08
1120 NW Couch St., Ste. 300
Portland, OR 97209 REQUESTED BY: Dianna Howse
Attn: Ray Glur
TRANSACTION INFORMATION:
Receipt #: 2007 -5385 Case #: BUP2007 -00627
Date: 12/11/07 Address /Parcel: 9600 SW Oak St.
Pay Method: Check Project Name: Conference Room
EXPLANATION: Per applicant's request as scope of work has changed. Refund 80% of permit fees only
as plan review was completed.
REFUND INFORMATION:
Fee Description. From Receipt . Revenue Account No Refund
Example: [BUILD] Permit Fee Example: 245 -0000- 432000 $Amount •
[BUILD] Permit Fee 245- 0000 - 432000 $90.04
[TAX] 8% State Surcharge 100 - 0000 - 207020 7.20
TOTAL REFUND: $97.24
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager i
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I w - /25/ %J I By I A
I: \Building \Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 6/19/2008
13125 SW flail Blvd. 1 1:34:18AM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000005385
Date: 12/11/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
BUP2007 -00627 [BUILD] Permit Fee 245- 0000 - 432000 112.55
BUP2007 -00627 [TAX] 8% State Surcharge 100- 0000 - 207020 9.00
BUP2007 -00627 [BUPPLN] Pln Rv 245- 0000 - 433000 73.16
BUP2007 -00627 [FLS] FLS Phi Rv 245- 0000 - 433020 45.02
Line Item Total: $239.73
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check GBC BB 25741 In Person 239.73
6e.o n Payment Total: $239.73
•
4
clteceipl.rpl Page I of I
•
Community Development CE
NED
1111
RE
TIGARD Request for Permit Action
JUN 19 2008
TO: CITY OF TIGARD CITY OFTIGARD
Building Division Services Coordinator B
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov UILDING DIVISION
FROM: ❑ Owner Applicant El Contractor El City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) G A ttec±• In corporatecf
Mailing Address: J l SO Ki , Co �� , cru i t Sao
I
V 0 1 D City/State /Zip: orti alwt OP 77209
e ., / /L" '- Phone No.: 503) 1.2.1- -9650
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
��. 1 CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES 'attach receipt, if available))
El INVOICE FOR FEES DUE (attach case fee schedule and explain below).
El REMOVE CONTRACTOR FROM PERMIT (do• not cancel permit). •
Permit #: p 2007 -0002.7
Site Address or Parcel #: 9 (oD0 s W Dale_ St.
Project Name: vdq `l C rkoopr) /20'031061
Subdivision Name: Lot #:
EXPLANATION: 1 -17 EXPII TTo week AGo. p.esoPktitrrokiG
l't-P • pop.. t'Aa (c /LLy 7 crow/6 W'0/24‹, , HOW EV& -. Co y' T c P/ZoJ(5
HAS a6-E,..) c/tEArrn (, - P� c � n �/ lau P 6 oo a-07
Signature: �Q�„�, Date: 6 • t<3 •O
Print Name: . . G I r
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date J o Z p By T-
Refund Processed: Date 6A-157e; By Invoice Processed: Date By
/
Permit Canceled: Date /$ ak By Parcel Tag Added: Date By
Receipt #07-53br5 Date /� // e 7 Method C46, Amount $
I:\ Building \Forms \RegPermitAction.doc ev 07/26/07 90 / C U 7 O _ / �• a ,!