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Permit
CITY OF TIGARD BUILDING PERMIT q COMMUNITY DEVELOPMENT Permit #: BUP2009-00035 T [ c A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2009 Parcel: 2S113B000600 Jurisdiction: Tigard Site address: 16580 SW 85TH AVE Subdivision: SEWER TREATMENT PLANT Lot: 0 Project: Clean Water Services Project Description: Infill of aeration basin channel. Owner: FEES CLEAN WATER SERVICES Description Date Amount 2550 SW HILLSBORO HWY Permit Fee - COM 03/04/2009 $1,785.20 HILLSBORO, OR 97123 Tax - 12% State Surcharge 03/04/2009 $214.22 PHONE: Plan Review 03/04/2009 $1,160.38 Plan Review - Fire Life Safety 03/04/2009 $714.08 Contractor: STETTLER SUPPLY CO INC 1810 LANA AVE NE SALEM, OR 97303 -3198 PHONE: 503 - 585 -5550 FAX: 503- 581 -6799 Specifics: Type of Use: COM Class of Work: OTR Dwelling Units: 0 Stories: 0 Height: 0 ft Bedrooms: 0 Bathrooms: 0 Value: $500,000 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $3,873.88 Required: Required Items and Reports (Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 This • mit is issued s• .'-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work w' be done in accordance WI • ap• • ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more e 180 days. ATTENTION: Or • • n law equ' s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 352- 001 -0010 through OAR 11 -01 . No6 obtain a copy f the rules or direct questions to OUNC by calling 503.24 .6699 or 1.80 .332.2344. v sued By: (K • UC � Perm ittee Signature: ,X^` 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 Commercial FOR OFFICE USE ONLY RECE72009D Received City of Tigard DateB : © e Permit No.: 1 pQ -Q6bj ■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev,ev �' i 11 Phone: IAT2 Other Permit: Phone: 50 Fax: 503.598.1960 MAR 0 Date/B T I G A R D Inspection Line: 503.639.4175 Date Ready r y: Juris: 0 See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: �� Supplemental Information TYPE OF / WING DIVISION 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 0 Other: equipment, materials, labor, overhead, and the profit for the - CATEGORY OF CONSTRUCTION work indicated on this application. 1=1 1- and 2- family dwelling Valuation: $ ❑ Commercial /industrial El Accessory building ❑ Multi - family Number of bedrooms: El Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: / 6 S ' -- 1- 1 2 J c. 6 IA/ gs-- New dwelling area: square feet City/State /ZIP: " q rte Q' Garage /carport area: square feet Suite/bldg. /apt. no.: V _/ Project name: 5 , c 0 „1 7 T + 0,4 Covered porch area: square feet Cross street/directions to job site: aC hi 4,14-1 -1 •f't'« 1 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. j' f • /1 /,-(- 4 rs 'i 'T a, s (4 / Valuation: $ n 11 ' f �! jhh/ 04 0(1 r', 4-- / f 9 9f ! t V! ' Existing building area: square feet New building area: square feet [k PROPERTY OWNER ❑ TENANT Number of stories: Name: K /r 7 -7 VI t r r Sf r vie r Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board 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: �� CONTRACTOR u7 777 Business name: 1 ' 7 J ?� f s• r � / BUILDING PERMIT FEES* IP IMP' Address: a.-- / (Please refer to fee schedule) t eA �� Structural plan review fee (or deposit): City /State /ZIP: 0, c7l--- Q75 , Phone: 6(j 3) 5 5'-- 568 Fax ( ) FLS plan review fee (if applicable): CCB lic.: -55A Total fees due upon application: Amount received: Authorized sigma C This permit application expires if a permit is not obtained -r+ within 180 days after it has been accepted as complete. Print name: J G a I C, ,3 O re �er_S Date: * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(I1 /02 /COM/WEB) I • Building Division Accessibility: Barrier Removal Improvement Plan TIGARD 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): $ I: \Building \Permits \BUP -COM PermitApp.doc 10/30/07 ■ • 1114 Building Division Plan Submittal Requirements T I G A R D Commercial & Multi - Family - New, Additions or Alterations 1. SITE PLAN (fully dimensional, drawn to scale) labeled with: A. El map & tax lot # ❑ project name El site address El suite number ❑ zoning El 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. I: \Building \Permits \BUP -COM PermitApp.doc 10/30/07 III I Building Division Plan Submittal Requirement Matrix TI G A R D 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. I: \Building \Permits \BUP -COM PermitApp.doc 10/30/07 Building Division Over- The - Counter (OTC) Building Permit TIGARD Check List Description of Project: r_ W�-� E C--. C t� h � 1 _ GENERAL INFORMATION Class of Work:* /\ L j Floor Areas (sq. ft.): Exterior Wall Construction: Type of Use:* (Q 4( First floor. N: S: Type of Construction: Second floor: E: W: Occupancy Group: Third floor: Openings Protected Y /N ?: Occupancy Load: Total sq ft.: N: S: Stories: Note: Combine total floor area for E: E: H ht: 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: r0�.11`r' Protected corridors: AA- Fire alarm: Parking spaces ( #): Notes: Total Valuation: $ INSPECTIONS FEES DUE Footing /foundation Firewall $ gets, 2_0 Permit Fee Post /beam structural Smoke detector $ ' • ZZ, State Surcharge Shear wall Misc. inspection $ Ut Plan Review Fee Masonry Approach /sidewalk $ ( , Ce 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 Tax Final inspection $ Misc. Fee $ Hourly Rate Fee $ Hourly Rate State Surcharge $ �3� Other: $ , jB7 , (..Total Fees Due 1 *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 ... ,— Mar. 11. 2009 7:54AM No. 4037 P. 1/1 . .. • ,, • RECEIVED Communit Development .. win 1 1 2009 ,., Request for Permit Action T "GARD . . . . . . . . . .. .. . . . .. .. . . . TO: CITY TIGARD . .Buildin Division Services Coordinator I .125 - SW [Jail BlVd., Tigard,•‘. /R. ( .)7223 Phone: 5033.18.2-130 Fax: 503.39.i %0 .WWW.riga l'il•Or.g0V. ---- ------iUCIII1111,DIN— VGerlDWGriON FROM: [j] Owner n Applicant El Contractor 0 City Staff 41,: liFFIND (.)R .Nfiinc:: Clean Water Service:; iNvoicE , ro : ; nu in, .4.ior I mirvirin ri: • ---''• ________ .....-- . .. _ _ __ ._..._ , Mailing AddreSS: - 16060 SW 85th • • • • • • -.-7. . Cin./StittetZip: _I it, ORi972;?,4 • . . .. . ... . • • • • • • • • . . . _ • Phone No.: ..(503) 547 . . PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL PkRMIT AppticATtoN. El v.121 PERMIT FEES •(attach receipt, if available). 13 IN VOICI 'FOR FEES DUE (attach.•casc fee schedule and expiain.below). E1 REMOVE CONTRACTOR FROM..PERNIIT (do not cancel permit). • -1 it; TWP . • • - - • - - . , sie....■(.1d1 bi- Parcel #.;. 16580 S\) 85' \ inue Tigard, OR 972.24 . Project Name: Secondary Ttain One Rehabilitation .. . . . .. ... .. .... . .. .. . 4 .Siihdiyision •Narne: — . 1.c.)t :: • • • EXPLANATION: llii estitnated prpjett \•-ilile, \k Tile actual bid.earne in At - S212,700: 1 woad like to reeeive a partial refund of die permit fee based on that value.. • • . • — • — col . ,•: - / • i • (-'-- ;:',/, . i Signature: r ''' > (1. . '''.• - •' '..7'14 . Date: March 11, 2009 e otek • :loel•C. Wit:ellen; • .• Print Name: ;•••"" _... .. ., 4 Bh P.ii:9 .i. ,n,„ o Dircctor 4n Iluildin:.; ( hirst . m tri ay urhotin the r ot' I.ittcd Sr :Inc Ft.c n hut. WaS 1111)11: CRISly p.li.i or c011o:trAt ar• • :I t nyr, °m .) prril tii" • or iilt. Lind t lk :Ipplicatim n v r Ikc when:iplicarion k w r 0 m ithc,r,rw: cca-dl.wfore .rcr:ew dio h rt .,, Petit evtr.ka :i.. I7 not mon. !km ttir I. of the land ■ n. vphLuion Inv furs:i.ncd 'It:anis. be, ,I.,.,1( i t niln lido AV:. ot ml t. buil4 lg. phn nwWw (o., what an ai)p!icith:,n iF C.Inc■.1cI in.,: :1,1■ 0 ni •Ii:view i hubCh A t'`.1?;oilvd. j1/4 or\ e, r . .V, L I I I .:m.. th 9 I/Vkiing rerk` I, if. i;:picd p..r.rnir: Lirior :0 ,uly Ii ill ell 1,.(r .cgs 2. ltcrunds. I. to th , )A:inal P•iys: ■!■ il■= it4r...' tot E- in ‘'ilici1PaYm,,V tent ro*"" J Pit 3'' ,lion. 14 ' (E. p ro";' ' 'f" ! " \ nd' V I6RkIFFICEIBE ONLY • - • • • • , • • . '.) V . ...., • ,. . • • Ric II i Ad Min: 1) iii. - it .0 I . Itial"A !!C:. .R At. 111611 : Pale By . ej l■ 4 . ........... . Refund Proc6s'e.d. litre lit Itivoiett:Pna-ta:gui: Dare lir IN i Permit Otncelcil: atic • 'i Par&l"fia \ Med: :Dalt; • 13v ..e.i■—■ • • . ReCeip[ # I ;ace Nretlicu.1 1 A11) S 1:\istiikhug\Fornt:\Rtgrer: naAculn.d.w Vee.n7126/07 III CITY OF TIGARD RECEIPT o I . • . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 2009 -00522 - 03/04/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID BUP2009 -00035 Permit Fee - COM 245- 0000 - 432000 $1,785.20 BUP2009 -00035 Tax - 12% State Surcharge 100 - 0000 - 207020 $214.22 BUP2009 -00035 Plan Review 245 - 0000 - 433000 $1,160.38 BUP2009 -00035 Plan Review - Fire Life Safety 245- 0000 - 433020 $714.08 Total: $3,873.88 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 167168 DADAMSKI 03/04/2009 $3,873.88 Payor: Clean Water Services Total Payments: $3,873.88 Balance Due: $0.00 •