Permit I II e . Community Development
TIGARD
Request for Permit Action
TO: CITY OF TIGARD •
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 XApplicant Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner 11 Contractor City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
.1� '� � :::t:.: •
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
X 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).
Permit #: _ <__ d- y 18 -C)07 /a
Site Address or Parcel #: 7/ 5o Cockvaot y am( 37z. Project Name: Pa // si f V
Subdivision Name: 1 - A I _ �� ,��� .. , . is S,. Lot #:
EXPLANATION: /)ty)i CO Ce -ee'' `.*(• X s
.gu 11 y IA e ; oy -/ sr �L .�i'7L A't-f "371 le-- cic) I. 7 .
7" x ....<-' � .. r-,
Signature: .. U Date: 6 GI r
/
/
Print Name: £ I - A , . � r
ger I"
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 . - or By -7, Rte to Bldg Admin: Date c ';/ ,17,,F By r, '
Refund Processed: Date ..lib?),,- By Invoice Processed: Date / By
Permit Canceled: Date :::/.7/1.71?" By f --- Parcel Tag Added: Date By
Receipt # Date Method Amount $
1: \ Building \ Forms \RegPemutAction.doc Rev 07/26/07
i a . NAf { U.5 1-fa S - _71 2 E 6 �z
Bruikliag Permit Application aq 608 co
Commercial
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`',1` City of Tigard C DateB �V(p �• Permit No. ��� � t 6 ° 13125 SW Hall Blvd., Tigard, OR 972
g P l an R e v iew
O Other Permit:
It 1 s III . `. Phone: 503.639.4171 Fax: 503.598.1960 9 Date/By: i.
l I G R Inspection Line: 503.639.41 \N Rp Date Ready /By: luris: Ei See Page 2 for
sziliaa;' Internet: www.tigard or.gov � CI v . l cy 0 Notified/Method: Supplemental Information
1 J 6
TYPE OF WGV LP ! REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition ' 1 `Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Nr Addition/alteration/replacement rates replacement Ether: equipment, materials, labor, overhead, and the profit for the
CATEGOR OF CON TRUCTION \ - work indicated on this application.
N v Valuation: $
❑ I- and 2- family dwelling Commerc /induct 1
❑ Accessory building ] Multi- famil} Number of bedrooms:
❑ Master builder IN Other: Number of bathrooms:
JOB SITE 1 1 ORMATION AND LOCA ON. - Total number of floors:
Job site address: 7/267 $w • C A/Z i1 C'N New dwelling area: square feet
City /State /ZIP: T( A 1(0 0 Garage /carport area: square feet
Suite/bldg. /apt. n. : Proje t name: ° A f/OMtsf S Covered porch area: square feet
Cross street/direction 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.
I 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 work indicated on this application.
kmouc Os c S . PL All ACE" aCet 5ffeaTi Val $
. eatZtICe ( cu < 1
E W/Tlf &Rick r0 Ii4Ttti Qxi strive• Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT . Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
eQ APPLICANT ` ❑ CONTACT. PERSON NOTICE . .
Business name: 306 epic !ILK fir S Co •.s51 CT D N All contractors and subcontractors are required to be
Contact name: 'rOM ROE licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 (1 2 S SIN got f V Q g t.✓o' jurisdiction in which work is being performed. if the
City /State /ZIP: Ti 6 OQ� applicant is exempt from licensing, the following reasons
f' apply:
Phone: (�� 4 ) Z�I` 73 (Tc Fax:: 6 S ' C6) 68q..5296-
E -mail:
CONTRACTOR • .
Business name: 5/ ?''t E BUILDING PERMIT FEES*
(Please refer to fee schedike)
Address:
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: t7 L(5 Total fees due upon application:
^ Amount received:
Authorized signature This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ON Rug Date: S-{Q— O8' * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02/COM/WEB)
Building Division
� Accessibility: Barrier Removal Improvement Plan
AR 0
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 be.deemed disproportionate to
the overall alteration when the cost exceeds twenry-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: [2J $
•
ELEMENTS: In choosing which accessible elements to provide under this' section, priority shall be given
to those elements that will provide the greatest access. shall 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
( p 24 i7(b
_ ' - 4.',' Plan Submittal Requirements
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.
1: \ Building \ Permits \BUP -COM PerrnitApp.doc 10/30/07
II
® Building Divisi ®n
Y ':7 !: :,'
4 Plan Submittal Requirement Matrix
T I G A 1t 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.
1:\ Building \ Permits \BUP -COM PemiltApp.doc 10/30/07
Community Development Cc)/ 7�
Request for Permit Action
IGARD`
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 S \V Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner El Contractor City Staff
(check one)
)21
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
V City /State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
n INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 2 tti o d - ai -,_)07-2a
Site Address or Parcel #: 774)-<S S60
Project Name: Pa //:s4/ 6I-oe
Subdivision Name: l .141 s , 4 � � Aya. ,5 Lot #: 6 / ST
EXPLANATION: /9 (.. //^C a, P7 ')/ 7 G ei v
/°e ;(7} sr / coo 1 76.
<„, Date: 6/ r
Signature: i _
Print Name: riA/CA
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 fcc when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80°'° of the land use application fcc 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.
c) not more than 80 °'o 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.
� . r T �, t c ,. ti p, ��.� �,,,, -� r � � Z �,,,� ,r t7 �^�� ;�� s�� � •u- n,
s 3" x - , a ., + FOR OFFI - 'USE ONLY i a ° :: T � � .VZggq���a
S i,,�_r..�Sar.,r+.s. 1C�4 P�r�.m.+.�LSK. - fit?''. .R.�o?`�i!'r,.'.�._r .. c._ sc _ ..., -r .. _. «,., . �... ,.w.+..i.,�iE. :,.�..,a..:.a�� �r��`'� ..u.� �'We. �l
Rte to S os Admin: Date e1� B ' �� Rte to Bld_ Admin: Date , f Ann B J4 -
Refund Processed: Date iJ / By Invoice Processed: Date By
Permit Canceled: Date 6/ j0,P By , Parcel Tag Added: Date By
Receipt # Date Method Amount $
1: \Building \ Forms \Rey Permit ction.doc Rev 117 /26/07