Permit 1114 ry
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00009
131 25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2011
TIGA . Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: Pacific Convenience & Fuels Subdivision: Lot: 0
Project Description: TI for remodel of foodmart.
Contractor: HILBERS INC Owner: PACIFIC CONVENIENCE & FUELS
1210 STABLER LN 2603 CAMINO RAMON STE 350
YUBA CITY, CA 95993 SAN RAMON, CA 94583
PHONE: 530 - 673 -2947 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 03/04/2011 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 03/04/2011 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 03/04/2011 $377.90
Stories: 0 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 03/04/2011 $45.35
Value: $20,000 Plan Review 03/04/2011 $245.64
Plan Review - Fire Life Safety 03/04/2011 " $151.16
Info Process /Archiving - Lg Sheet (over 03/04/2011 $14.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $907.05
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No 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 - • • - ce 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. TENTION: O.ton law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 101 -0010 through OAR 15 %11 -0i 90. You may obtain a copy of the rules or direct questions to O • calling 503. VA - 7 - .' • • 2.2344.
Iss ed By: k /�Ij/ �„ / Permittee Signature: r
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 RECE V Et FOR OFFICE USE ONLY
City of Tigard JAN 1 2011 Recei DateB ve : d
1
Permit No.: 4 /Q ' elG069
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G Phone: 503.718.2439 Fax: 503.598.1960 TI GARD Date : 1v .. Other Permit. j
T I G A It D I
Inspection Line: 503.639.4175 CITY OF Ready :y: VI See Page 2 for
Internet: www.tigard - or.gov BUILDING No tified/Method: /f` Supplemental Information
` I L I! [ I[.
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.
Valuation: $
❑ I- and 2- family dwelling Commercial /industrial
1=1 Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE Ii�TFORMATION ID N Total number of floors:
Job site address: Ls �-/ Ij772 ' 513 -7 /AO ' j , :� New dwelling area: square feet
City /State /ZIP: 7< r �� 3 ' 70 l
'� Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ,j -FJ/ �y - Z (,/f' 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: I 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. �,
. iliOD X f - f ',D,, a-7 Valuation: $ �0 JV
/ 0 � , �7 Existing building area: square feet .
P Y New building area: square feet
Or PROPERTY OWNER ❑ TENANT Number of stories:
, r / 3 3 / y[ // 7 C'E 4 P il 4- c Type of construction:
Address: ! (03 C�),-7 p,4iV'°flf 3_5 Q Occupancy groups:
City /State /ZIP:(_5411 .1007sf dJ 9 V S3 Existing:
Phone: ( ) Fax: ( ) New:
tg APPLICANT ❑ CONTACT PERSON NOTICE
Business name: - ,42 9-6 c (r /��' �I /I All contractors and subcontractors are required to be
Contact nar�� v 405.59 S licensed with the Oregon Construction Contractors Board
Al nder ORS 701 and may be required to be licensed in the
Address: 81'3 / pp UrV < s A jurisdiction in which work is being performed. If the
City /State /ZIP: /pQee104 !%_ ",2Q 2 / applicant is exempt from licensing, the following reasons
OW �y �9 ? apply:
Phone: �2 g -t/ I Fax : : 67,35 01 374> �
E -mail:
CONTRACTOR 'I D
Business name: ilit/L /3&72.,.S f /NC BUILDING PERMIT FEES*
(Please refer to fee schedule)
Address: 42 /O S 7?9 L-&. LA/ r
Structural plan review fee (or deposit):
City /State /ZIP: /Li 64 C (T / y C ?SS 93
Phone:
�3o) — 9y I ( ) FLS plan review fee (if applicable):
F ax :
Total fees due upon application:
,Q6 lie.:
Amount received:
Authorized signature: T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1 O ,jA 0 ,� Date: 6 -3 ./ / * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits \BUP -COM PermitApp.doc 09/09/10 440- 4613T(11 /02 /COM/WEB)
•
1, " 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: [I] $
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 06/25/08
4.!
III ii, Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: .P II- p6OO f ❑ Expedited Review
Plan Submittal Date: OOP/
/s9o0 0 146 79 =Cl O
To the Applicant:
➢ If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
> If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved. /'r 3 S l //JJ110301J
Planning Review (contact !r; at 503 - 718 - °Wv or @ tigard- or.gov)
❑ Zoning `' Permitted Use Yes ❑ No ❑
❑ Land Use Re quired: Yess 0 No ❑ (explain below)
Notes: be / 4' /�Pi' ,-" A/51,>�4. mw/ m e / 77, 3rP. 4,. . i"
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l ru ACA /�Jl : - G(b.' ✓ice . ��, - Pi"—
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Approved ❑ Not Approved Date: r ' / //
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.gov)
Notes:
Routed back to Building Division Date: / AI' Ar
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