Permit r CITY OF TIGARD BUILDING PERMIT
a - COMMUNITY DEVELOPMENT Permit #: BUP2010 -00101
_ Date Issued: 06/01/2010
TI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
.w ,,fi Parcel: 2S110DB00500
Jurisdiction: Tigard
Site address: 15336 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Sonic Drive -In Restaurant
Project Description: 20' freestanding sign.
Owner: FEES
MWF TIGARD LLC Description Date Amount
2123 NW ALOCLEK DR #1203 Permit Fee - Additions, Alterations, 06/01/2010 $347.48
HILLSBORO, OR 97124 Demolition
PHONE: 503 - 617 -0175 Plan Review 05/14/2010 $225.86
12% State Surcharge - Building 06/01/2010 $41.70
Contractor:
VANCOUVER SIGN COMPANY INC
2600 NE ANDERSEN RD #50
VANCOUVER, WA 98661
PHONE: 360 - 693 -4773
FAX: 360 - 693 -2747
Specifics:
Type of Use: COM
Class of Work: NEW
Dwelling Units: 0
Stories: 0 Height: 20 ft
Bedrooms: 0 Bathrooms: 0
Value: $18,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $615.04
Required: Required Items and Reports (Conditions)
1 BUP Structural Welding
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. ATTEN .10N7Oreg law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -001'0 through OAR -0 - 100. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246 699 or 1 0.332. 344.
Issued B� r Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that busines day.
This permit card shall be kept in a conspicuous place on the job site until c pletion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
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' f. City Of Tigard 6 Received r Permit No.: r 00101
IN
13125 SW Hall Blvd., Tigard, OR 97223 Q1 Date Plan B Review y 1 ] ��� �V
C ;,, Phon 503.639.4171 Fax: 503.598.1960 '_ ", NM= Other Permit: Q ,. Iu : r
�JJ ��
1 1 t(.; it t Inspection Line: 503.639.4175 MP\ ° , Date/B r e Ready /By: / Juris: ® See Page 2 for
:i Internet: www.tigard- or.gov "` O � ec , - o t ifie ethod: (0 / ( y Supplemental Information
(tsj TYPE OF WORK ov" REQUIRED DATA: I- AND 2- FAMILY DWELLING
14 New construction ❑ Demol 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: $
❑ 1- and 2- family dwelling 'Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCAT ON Total number of floors:
Job site address: / 5 336 S W 14 w y 19 PaL 1 } ; C.. 14 W " New dwelling area: square feet
City /State /ZIP: -t' ; eta fa t O Q ' 7 ZZ � l Garage /carport area: square feet
Suite/bldg. /apt. no.: J Project name: 0 el.; L pt ,, 1 l/f _j, f adawl + 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: 1 Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK r work indicated on this application.
(1) T tEE.S"t an r� n Valuation $ 2 ti_. /' l �k)
I
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories:
Name: S i.d C.. Type of construction:
Address: is 33 60 5 I .tN • r 0. G t c t c.. l4 1...11. Occupancy groups:
City /State /ZIP: --c;(6,,, r c t o IS 9 7 2 2 2( `J Existing:
Phone: ( ) Fax: ( ) New:
Bf APPLICANT IS CONTACT, PERSON NOTICE
Business name: V&A C 6 au el, s; r All contractors and subcontractors are required to be
S�O r J licensed with the Oregon Construction Contractors Board
Contact name:
R ei t under ORS 701 and may be required to be licensed in the
Address: 2 (. O 0 NE A n creseri Rd -st, 0 jurisdiction in which work is being performed. If the
p 6 p applicant is exempt from licensing, the following reasons
City /State /ZIP:
Valle QU U e. ( � O ( apply:
Phone: ( 3(v0 ) (0 i3 2{77,3 �Fax::(360) 6,q3 2_7L{7
E -mail ('e;QiS Va. 5/'cj /2G0, cone)
� J ONTRACTOR
Business name: va lc, 0 L k e, c c ``� i n
BUILDING PERMIT FEES *
Address: z (, O 0 A/6 A n�lr e g en Rd, #go (Please refer to deposit):
schedule)
Structural plan review fee (or deposit):
City /State /ZIP:
VcL e Lc 0 uweJC L ii A c /$ 6 6 I
Phone: (3( 413 2 17 7 3 Fax: (3(0 6/ 3 z 7 t{ "T FLS plan review fee (if applicable):
CCB lic.:
r� 1 Total fees due upon application: S',
Amount received: )7)-5`We
Authorized signature: /� This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
Print name: R ;1, Eta r Date: s in3 Z Q /Q * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
�
Is
1 Building Division
.:" Accessibility: Barrier Removal Improvement Plan
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): $
•
•
L \ Building \ Permits \BUP -COM PermitApp.doc 06 /25/08
6 L „z2 24/6am • -Cz/G1
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
• ,t1
III AVRID,
October 28, 2010
Vancouver Sign Company, Inc.
2600 NE Andresen Rd., Ste. 50
Vancouver, WA 98661
Re: Permit No. BUP2010 -00101
Dear Sir /Ms.:
The City of Tigard has processed a refund for overpayment of permit fees on the above
. referenced permit for the following:
Site Address: 15336 SW Pacific Hwy
Project Name: Sonic Drive -In Restaurant
Job No.: N/A
Refund: ® Check #67546 in the amount of $9.00.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Applicant's check was written for $9.00 over amount due for permit fees. See
attached for copy of check and original receipt.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I: \ Building \ Refunds \ Administration \1.,trRefund- Overpay.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 Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Vancouver Sign Company, Inc. DATE: 10/20/2010
2600 NE Andresen Rd., Ste. 50
Vancouver, WA 98661 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 178146 Case #: BUP2010 -00101
Date: 06/01/2010 Address /Parcel: 15336 SW Pacific Hwy
Pay Method: Check Project Name: Sonic Drive -In Restaurant
EXPLANATION: Check written for $9.00 over permit fees due.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Cash Over 1003100 -48001 $9.00
TOTAL REFUND: $9.00
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager ' 7 C7 2 -Gl/ c�
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 /j)' /Zc //O 1 By: 1 ,i
1: \Building \Refunds \RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
II
liql C . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 180157 - 10/28/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010-00101 $-9.00
Total: $ -9.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
• Check 71197 OHOWSE 10/28/2010 $ -9.00
Payor: Vancouver Sign Company, Inc.
Total Payments: $ -9.00
Balance Due: $9.00
Page 1 of 1
CITY OF TIGARD RECEIPT
I
_ • 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
(-72/67 4/9
Receipt Number: 178141 - 06/01/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010 -00101 Permit Fee - Additions, Alterations, 2300000 -43104 $347.48
Demolition
BUP2010 -00101 12% State Surcharge - Building 1003100- 24001 $41.70
Total: $389.18
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 71197 DADAMSKI 06/01/2010 $389.18
Payor: Vancouver Sign Company Inc
Total Payments: $389.18
Balance Due: $0.00
Nift
VANCOUVER SIGN COMPANY, INC. COLUMBIA STATE BANK 71197
2600 NE ANDRESEN RD. SUITE 50 400 E. MILL PLAIN BLVD., STE. 100
VANCOUVER, WA 98661 VANCOUVER, WA 98660
34 82711251 /
(360) 693-4773 r o // /de) /0 ..
Vancouver sign R
Group
PAY TO THE dteitt.C..rik___ ...
ORDER OF 7 I ��� c .7.
41 Cr , .e j'I_l 6tr?0 , n,init ° � /Da DOLLARS '
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MEMO � j�
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AUTHORIZED SIGNAT v