Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
a
4f
October 28, 2010
ACH - Tim & Mindi Brizendine
17047 SW Barcelona Way
Beaverton, OR 97007
•
Re: Permit No. BUP2010 -00086
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: 12725 SW Pacific Hwy
Project Name: Adrangi
Job No.: N/A
Refund: ® Check #67469 in the amount of $122.99 ($66.01 + $56.98). .
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Project valuation was reduced from $5,640.00 to $3,940.00. Refund difference of
permit fees in the amount of $66.01. Balance of $56.98 on check for ELC2010- 00203. See
refund explanation under separate letter.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- Overpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
• `^ ;. 1-� CITY OF TIGARD BUILDING PERMIT
I
2 COMMUNITY DEVELOPMENT
Permit #: BUP2010 -00086
" ` Date issued: 05/04/2010
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102BD00600
Jurisdiction: Tigard
Site address: 12725 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Adrangi
Project Description: Repair and replace framing in rear wall, flat roof & floor on North side of building.
Owner:
FEES
ADRANGI, FARID Description Date Amount
4289 ORCHARD WAY Permit Fee - Additions, Alterations, 04/28/2010 $134.54
LAKE OSWEGO, OR 97035 Demolition
PHONE: 503- 719 -2174 12% State Surcharge - Building 04/28/2010 $16.14
Plan Review 04/28/2010 $87.45
Contractor:
Plan Review - Fire Life Safety 04/28/2010 $53.82
WALL 2 WALL CONSTRUCTION LLC
2850 SW CEDAR HILLS BLVD #63
BEAVERTON, or 97005
PHONE: 503 - 789 -7239
FAX: 503 - 530 -8268
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 1 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $3,940
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $291.95
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors: No
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. ATT N I? ON Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 through OA 95 ;11-0100. You may (Al- in a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: i/ Permittee Signa • e: � � � ��
Call 503.639.4175 by 7:00 a.m. for an inspection that busin:ss 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 !l�11ppp
Commercial "� �� Olt`c)I I Ic l util cllyl
� � C -g i :IvAt. ^ / ,..—, , . „, .- + ; a N :. ,.:� a 5
. _ • a 13125 SW Hall Blvd., Tigard, OR 97223 City of Tigard p Received eivi 1.7/ D /d / Permit No.: �/a COO.: /
�A an Reve � �
' ;'• . ® `:. Phone: 503.639.4171 Fax: 503.598.196UTAY 4 2010 Da R : �`�� � � Other Permit:
,'I -I C A R-ii Inspection Line: 503.639.4175 Date Ready Ty: Juris: ® See Page 2 for
• . Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK 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.
• R Valuation: $
El I- and 2- family dwelling J i Commercial /industrial
El Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION • Total number of floors:
Job site address: f 2 Z 5 cir'' • p6%-C1 'C.... )4 y t New dwelling area: square feet
City /State /"LIP: � f ` , (ti d, o p / Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: fi t 'd ' 5- 3 f g uv et V C+ Covered porch area: square feet
Cross street/directions to job site: -p act f ,•C L7 wY) " mss/- u-, IA/ Deck area: square feet
p,, �
b4? 1•"' if 1Ck 1' I by — Other structure area: square feet
/ REQUIRED DATA: -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.
Valuation: $ 3 l Lk , —
Existing building area: square feet
New building area: square feet
PROPERTY OWNER • ❑ TENANT Number of stories:
Name: c4 v t' d (1- a1(a v y ; Type of construction:
Address: 0 C ckaArd t.clAry Occupancy groups:
City /State /ZIP: V ,) Existing:
Phone: ( 5J3) 7 19 - 217* Fax: ( ) New:
ICI APPLICANT . a CONTACT PERSON., NOTICE •
Business name: W &1 w 4) C.� w 51L All contractors and subcontractors are required to be
�j Z licensed with the Oregon Construction Contractors Board
Contact name: �+
Y, t . t /Yr ��61r M. under ORS 701 and may be required to be licensed in the
Address: 1 7 0 47 5 -v- - g C2. 1 ° t^ q U- 6 jurisdiction in which work is being performed. I f the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: (5u 3 ) 7 $ t —12 1 y Fax:: ( 5'03) 5 0 - 8 2 6 1
E -mail: pp et-o(fky �Mi..1l►'� h °tw+sa1d. eOV'.•
CONTRACTOR' _ '
Business name: t,,)4 Z V11 i Cp v•t,A- - > L L BUILDING PERMIT,FEES* '
Address: 2 ,15' Q 5 i m. c � V - r tl S 131 v . , + , 'y' C3 (Please refer ro lee schedule)
� Structural plan review fee (or deposit):
City /State /ZIP: 9.Q(tve;l(toin. 0 f ell. p5 ) FLS plan review fee (if applicable):
Phone:( 51.3 ) 7 Fax: (5o3) 53O -s Z 6 $
CCB lic.: 1 Dq 51 k ill' /if Total fees due upon application: 1.7:1/ S /
Amount received: • y
Authorized signature: p("-J.41 A1/4i0141 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: f AY;., E , P y (41( Date: c - 3 — l U * Fee methodology set by Tri- County Building Industry
/ Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
. City of Tigard
Ti 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: ACH - Tim & Mindi Brizendine DATE: 10/20/2010
17047 SW Barcelona Way
Beaverton, OR 97007 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 177723 Case #: BUP2010 -00086
Date: 4/28/2010 Address /Parcel: 12725 SW Pacific Hwy
Pay Method: Check Project Name: Adrangi
EXPLANATION: Per applicant's request as project valuation was reduced; refund difference of permit
fees from $5,640.00 to $3,940 vaulation.
REFUND INFORMATION:::: ' " r ,.
- Lee ` -D "esc i pticrn From�Receipt: Reve > }e:Account:No.= R e f und.:
Example: Buildinj; Permit -Fee = : = Example , 3000Q0 -43104 $`Amounf•'
Building Permit - COM 2300000 -43104 $66.01
TOTAL REFUND: $66.01
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager <__-- &'_ (O, /- % t o
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 / /2,y e I By: I 4 w---
1: \ Building \ Refunds \RefundReyuestdoc x 09/01 /2010
CITY OF TIGARD RECEIPT
U
'. g 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 180160 - 10/28/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010- 00086 $ -66.01
Total: $46.01
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 67469 DHOWSE 10/28/2010 $ -66.01
Payor: ACH - Tim & Mindi Brizendine
Total Payments: $ -66.01
Balance Due: $66.01
Page 1 of 1
CITY OF TIGARD RECEIPT
•
n
C 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIG ARD �a
or ✓t , fitrr-9Z -
Receipt Number: 177723 - 04/28/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010-00086 Permit Fee - Additions, Alterations, 2300000 -43104 $134.54
Demolition
BUP2010 -00086 12% State Surcharge - Building 1003100 -24001 $16.14
BUP2010 -00086 Plan Review 2300000 -43106 $87.45
BUP2010 -00086 Plan Review - Fire Life Safety 2300000 -43108 $53.82
BUP2010-00086 Building Permit - COM 2300000 - 43104 $66.01
Total: $357.96
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 6623 DADAMSKI 04/28/2010 $357.96
Payor: ACH - Tim & Mindi Brizendine
Total Payments: $357.96
Balance Due: $0.00
Page 1 of 1
r
l o ° Community Development �..,
TIGARD Request for Permit Action RECEIVED
MAY -4 7.C10
TO: . CITY OF TIGARD CITY OF TIGARD
Building Division Services Coordinator BUILDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 'J )' B r ; Levy! 1 .1_ A
Mailin Address: 11 0 4- 7 5 t• 13k.r c.e.1 .41,..q «a y
City/State /Zip: B,e_CiV CY' +6 h. O (z, q 7 °.' 7
Phone No.: 5 — 7 g q— 7 Z 37
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available). --- C z' + `
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: J:)u P AO/1)-66616
Site Address or Parcel #: 1 2,7 aS j j) .., pi L'. A
Project Name: Prl,CR t I
Subdivision Name: A)///` Lot #: AlJA-
XPLANATION: 0 V t: � 4 o � n - LL. l ' i.v i. i 4 5 .- V
1 k
/6 t✓et V4zu. 7cr � i / ..s 4 /0 Tzl 702V�)
Signature: / ` / 5 — 0 lgn ,c.w., (3 Date: � r
Print Name: f i h. 13 r i -z.r2 vt(J I M _
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 OL LICE; USE ONLY
Rte to S s Admin: Date S y /D 1 : 1 2 1 1 , 1 ! ) ' J Rte to Bld. A d , i i . D. t- • AP B tir _� .
Refund Processed: Date /� LJ ' 'c By Invoice Processed: Date By
Permit Canceled: Date iV //�-/ -f By hip Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
.
T otal ^' ,5 q ye ----
• VaValua $ .
i
— INSPECTIONS �._ l r — , _ FEES DUE PooThin}; /fuundatiou Firewall $ Permit Fee
Pmst /beam stzUU Smoke detector 5 -t 1 4:0 A „... Star Surcharge —
Shear wall Misc. inspection $ 1 On. 2 - Pilo Review Fee
Maloney - Auproath!sidew:d4 $ 6. Cfi Fl c Plan Review Fee
Framing - -
Fram S _ _� Additional Pennit Fee
— Insulation. Sprinkler tough-in -$ ^__ Additional Plan Review nee
— — Gyp board — , : in alarm $ _ Metro Construction l &i c'Pax y .
_.— Suspended ceiling Spnnkkr final $ School Cont,ttuction Lxcuse Ta ` .
Final inspection S _ __ ._ . __ _.., Misc. Fee V
S Hourly Rate Fcc `� �j`` ,��
- -_ $ 7 / y lou:rly Rate Stare Surehl)r c ` �t
$ ��47� uta Fees Due
ap /.9s
moo: --- _ —.
TYPE OF USE: COM = commercial; CMS r commercial nunufsenued arn:cture. •
CLASS OF 1 ORK ACS accessory; ADD = addition: ALT -: alreratitn; END = fotmdaiton; DE.M = demo;
j 11Z) _ foundatiuu; FPS = fuc ptutecuoo sv;tcm: N W new OTR - other (use for fences decks, «txinina walls, signs, awnings
or canop:ca); REP = repair. - —.
•
Building Division
Accessibility: Barrier Removal Improvement Plan
T.f GA R D:
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 [21 of Valuation Computation): $
1:\ Building \ Permits \BUP -COM PermitApp.doc 06 /25/08
111 e ° Building Division
Over- The - Counter (OTC) Building Permit
T l c n iz Check List
Description of Project: (
GENERAL INFORMATION ..
Class of Work:* . A t T' Floor Areas (sq. ft.): Exterior Wall Construction: _
Type of Use:* ^(,t First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Z Third floor. Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: N: S:
Stories: ( Note: Combine total floor area for E: E:
Height: _ all floors above third floor and Roof Construction: _
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: Handicap access:
Smoke detector: Protected corridors:
Fire alarm: V Parking spaces ( #):
Notes:
Total Valuation: $ 6 s / `
INSPECTIONS FEES DUE
Footing /foundation Firewall $,�� Permit Fee
Post /beam structural Smoke detector $ l� , &) State Surcharge
Shear wall Misc. inspection $ 1` 7,22 Plan Review Fee
Masonry Approach /sidewalk $ ( FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Ta `
Final inspection $ Misc. Fee \
$ Hourly Rate Fee
e �
$ ourly Rate State Surch rge
$ 1 PC- , Other: I 0 #-
. \Z'
$ �i otal Fees Due
a g!• 9s
*OPTIONS: .
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure. '
CLASS OF WORK: ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences decks, retaining walls, signs, awnings
or canopies); REP = repair. .
I: \Building \Forms \OTC - BUP.doc 08/19/08