Permit CITY OF TIGARD BUILDING PERMIT
° COMMUNITY DEVELOPMENT Permit #: BUP2009 -00077
AC GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/09/2009
Parcel: 2S101AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: 2 story office and dental building - block construction net square footage under 5,000 sq. ft. per
floor 2 existing homes to be demolished
Owner: FEES
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD Permit Fee - COM 09/04/2009 $3,676.88
BEAVERTON, OR 97007 Plan Review 05/11/2009 $1,160.38
PHONE: Plan Review - Fire Life Safety 05/11/2009 $714.08
TIF -Mass Transportation 07/02/2009 $6,925.00
Contractor: TIF - Office 07/02/2009 $73,019.00
OWNER TDT - Transportation Development Tax 09/04/2009 $3,294.00
Plan Review 09/04/2009 $1,229.59
Plan Review - Fire Life Safety 09/04/2009 $756.67
12% State Surcharge - Building 09/04/2009 $441.23
PHONE: Metro Const. Excise Tax - Commercial 09/04/2009 $1,466.02
FAX: Use
Additional Plan Review 09/04/2009 $200.00
Specifics: CDC Bldg Review, COM 09/04/2009 $143.50
Type of Use: COM CDC Plan Review, COM 09/04/2009 $143.50
Class of Work: NEW CDC Plan Review, COM - LRP 09/04/2009 $42.00
Dwelling Units: 0 Erosion Control 09/04/2009 $328.00
Stories: 2 Height: 17.5 ft Erosion Plan Review CWS 09/04/2009 $106.60
Bedrooms: 0 Bathrooms: 0 Erosion Plan Review COT 09/04/2009 $106.60
Value: $1,221,685 Tig -Tual School CET - Non Residential 09/04/2009 $5,580.00
Park - Commercial and Industrial 09/04/2009 $649.56
Floor Areas:
Total Area: 11160
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $99,982.61
Required: Required Items and Reports (Conditions)
1 Pln G- MODIFICATIONS RE. PLANNING APPRO\
Fire Sprinkler: Yes Parapet: No 2 Pln Gen STREET SIG TION FUNDS
Fire Alarm: Yes Protected Corridors: No 3 Pln Gen - - t E COVERAGE & LANDSCAPE % CA
Smoke Detectors: No Manual Pull Stations: No 4 Pln Gen DSC• • =u DETAILS
Accessible Parking: 2 5 Pln Gen FRANCHISE WASTE • -- SIGN -OFF
6 Pln Gen TRASH ENCLOSURE DETAILS
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 acco . -, e 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. AT - TION: Orego -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR •
952 -01 -0010 through OAR 9 • 00 r0. You may obtain a copy of the rules or direct questions to OUNC by c- g 503.246.6699 or 1.800.332.2344
Issu • • By: Permittee Sig .ture:
Call 503.639.4175 by 7:00 a.m. for an inspection that business d. . r
This permit card shall be kept in a conspicuous place on the job site until- • • pletion of the project.
Approved plans are required on the job site at the time of each inspection.
. .
.-
- Building Permit Application
I RECEIVED -•'..,,,: c,-...E.:(3 bNi ::7 4%.'',,,l'
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Received
City of Tigard MAY ii 2009 Date/B . -. ' CS 1.4& . Permit No.: ,, P falbil , •git 41
.:: ,?..• . '... 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.196trry OF TIGARD D . , w ,d uk=11111M 1 Other Permit:
•t
Inspection Line: 503.639.4175 Date Re ..7:
11• 6 f \ 'Iil?. liffill lil See Attached Checklist for
,
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
r,':,,i.'-je4'.;;:tif4;46::..ki-',1,4::A4c-l",',7tt'S'"MII.-; TOPE::,•CiFT41711:41Z;i:Yii,11:::',-':.i°1;'4;:,44-;71;r,.';.fil : 4
1:21 ew construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
El Addition/alteration/replacement Ej Other: equipment, materials, labor, overhead, and the profit for the
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, eil:: ,, i;: . ,: , '.4- ,- - % isipefi uc i s ii
-ofi. work indicated on this application.
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Valuation: $
El 1- and 2-family dwelling ErCommercial/industrial
U Accessory building El Multi-family Number of bedrooms:
0 Master builder El Other: Number of bathrooms:
•<;,- -- ,-•-,,-. 5.-;• - - ; • •-. - - .--`" ' ''. •" ,- '-'' ' 'r-- ''''' '''-- ' -- ' , 14 . --ii:;,; , ::',I.Y....a. , ,:.,:ii 44: Total number of floors:
''-'.•'i '•.-'i- -i'''- ''"Y' -' JOB SIT INFO ATION;ANH.'LOCATION ifft „..,....
Job site address: - 7 0 9 1- D ..- -7 1 < s I, C:,(; 2./1. c,,ej New dwelling area: square feet
City/State/ZIP: T ■ r A _ c, c).(1_ 97 C,1:1-- 3 Garage/carport area: square feet
Suite/bldg/apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
7 X-- 0 3 )j.-A- Other structure area: square feet
:',4EQUERIgt DATA:rCOMMERCIAL4JSE CHECKLIST.
Subdivision: Lot no.: A ) Permit fees* are based on the value of the work performecl.
Indicate the value (rounded to the nearest dollar) of all - • _...------
Tax map/parcel no.: c , . 5 to ( . _ ..4 : e .. , . . .. . . .,. . ... , „. equipment, materials, labor, overhead, and the profit for the
;:,;' :., : , Ii A l s' %NY% - ;,: 11` ,=■fliy:84 , cliipi . :: thsi,".&.41:iRk 4 •i'•;g work indicated on this application.
,.......----
Valuation:
COV‘..-VT V C c Prth ri e-- i --7- -2 - r I •Oiti S .-- .,....97.1
Existing building area: square feet I 1 1 (
o .
/
New building area: square feet..,
0 illioiER Ef: ,:;:*41:.:f.„4";;.: Number of stories: 2_,.
Name: 11/1} i i 4 eV) L q l' f Y (.. u 171 (., Type of construction: /2 A : _
Address: IlultJ I ; Iv 1• / Occupancy groups: 8 4....
City/State/ZIP: 1 ei1 Gr 17 '''. \ ' Existing:
Phone: ( cd 3) Tyt Tyt,..; Fax: ( ) 6;1. ) c )3 I New
''. • .- 1. • : . ; , , ; ,.f ,, '.‘, ,_,,=, .c, ,.„,, .:. , CONTACT .r.F.4soN.%,...,..,0. -
itii:
Business name: All contractors and subcontractors are required to be
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Contact name:
licensed with the Oregon Construction Contractors Board
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3' c t... ,-
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51jul (-- 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'( ) Fax: : ( )
E-mail:
:',,l':"•: ..1 , : - :..- * -66 - NiRA&T'oi- ,..:.,,,,,,,:::'-:::„':::''',,,,,-
Business name: OuDO cu.,4 h \... ch 1-w. N cb „,
Address: I ,, ,r :::,i; :1' . ..;,.':, ..,,; (Please trferiolee scheiiile)” ''''''' '
Structural plan review fee (or deposit):
City/State/ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
CCB lic.:
N ■. ....- Total fees due upon application: te)1414
Amount received:
Authorized signature: \ M 1
This permit application expires if a permit is not obtained
I within 180 days after it has been accepted as complete.
Print name: ..,,, 1 S ; 0 1 4 rl I rl Date: 5 .1_01 . Fee methodology set by Tri-County Building Industry .
il Service Board.
I: \ BuildingTermits \ BUP-PermitApp.doc 03/2/06 440-4613T(11/02./COM/WEB)
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Building Division
System Development Charges
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4-7*','''' c 4. , •" , : 4f..;' . ` n: : . 4t lfi ? t. T, } ', .k, S u b mittal's. ; _
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, o
Fire Protection System 2 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2 J
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: \Building \Forms \COM- PlanSubRegMatrix.doe 06/29/06
CITY OF TIGARD' ecitekt 7
7
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 47/ # 1 09•1111
Inspection Requests (24 Hrs.): (503) 639 -4175 s " A
INSPECTION WORKSHEET FOR DATE: 3/ \ TIME: PAGE:
SITE ADDRESS: ! CLASS OF WORK:
SUBDIVISION: (C 1, LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: r
OWNER: PHONE #: 7t'(1 -a(1-lu
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
711)5 ov9Fao--01
Corrections /Comments /Instruction :
___ ,,_c li t___,,,, :_ .
''e--1_ w1 S
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
DikkIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ���,� Date: Phone #: (503) 718- 1
•
•
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
II
Wednesday, December 16, 2009
T I GARD
Mr. John Skourtes
National Safety Co.
17010 SW Weir Rd.
Beaverton, OR 97007
RE Transportation Development Tax (TDT) Refund.
Permit No. 1'2009 -00077 for 7095 SW Gonzaga St., National Safety Building.
,Bccf
Dear John:
At the time the above building permit was issued you paid a Transportation Development
Tax (TDT) fee of $3,294.00.
Effective December 1, 2009, Washington County approved a Temporary Discount on TDT
charges and has made that discount retroactive to July 1, 2009.
The enclosed check represents a refund to you of the difference between your original TDT
payment for your project and the new Temporary Discount charge. The amount of the
credit refund is $659.00.
Please call m 03- 718 -2426 if you have any questions.
ii 44----
Albert Shields
Permits /Projects Coordinator
503 - 718 -2426
Phone: 503.639.4171 • Fax: 503.684.7297 • • www.tigard - or.gov • TTY Relay: 503.684.2772
� q
City of Tigard
TIGARD Accela 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 Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: National Safety co. DATE: 12/10/09
17010 SW Weir Rd.
Beaverton, OR 97007 REQUESTED BY: Dianna Howse
AMS
TRANSACTION INFORMATION:
Receipt #: 175101 Case #: BUP2009 -00077
Date: 09/04/09 Address /Parcel: 7095 SW Gonzaga St.
Pay Method: Check Project Name: National Safety Building
EXPLANATION: Refund amount discounted for TDT per Washington County.
=REFUND:INEORMATION:. r .. .. _
Fee: escri _`uon Fron :Recei t ;.:: �:� =.= Revenue Accountrlo::'. ;. Refund
'�Amou
'Esamjile:• �[BUILD]:.Periiu , . e:,.. _,.. . � ...., ... ..- .. P - ..- .... .. .
TDT - Transportation Development Tax 4050000 -43320 $659.00
TOTAL REFUND: $659.00
APPROVALS:
If under $000 Professional Staff 1 1 0 . ,/
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
'TOR AC CELA`$SYSTEM=ADMINISTR°ATION USE
Refund Request Reviewed: Date: f 2/4•1( By:
Case Refund Processed: Date: d , x / � ' - "' By:
9 2 -
I : : \Building \Refunds \RefundRequest.doc 04/13/09
CITY OF TIGARD RECEIPT
y Q
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 176348 - 12/18/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2009 -00077 $ - 659.00
Total: $459.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 102160 DHOWSE 12/18/2009 $- 659.00
Payor: National Safety Co.
Total Payments: $- 659.00
Balance Due: $659.00
Page 1 of 1
CITY OF TIGARD RECEIPT
• ; 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
1IGARD
Receipt Number: 175101 - 09/04/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2009 -00077 TDT - Transportation Development Tax 4050000 -43320 $3,294.00
Total: $3,294.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1352 DADAMSKI 09/04/2009 $3,294.00
Payor: National Safety Co
• Total Payments: $3,294.00
Balance Due: $0.00
•
Page 1 of 1