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Permit ,, CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit #: BU P2011-00140 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/21 /2011 Parcel: 2S 110DB01700 Jurisdiction: Site address: 15290 SW PACIFIC HWY Project: Black Rock Coffee Shop Subdivision: 1996 -010 PARTITION PLAT Lot: 2 Project Description: Placement of new commercial manufactured structure for coffee drive -thru. Contractor: OWNER Owner: JESS WETSEL 10110 SW NIMBUS AVENUS SUITE B -9 PORTLAND, OR 97223 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Type of Use: COM Permit Fee - COM - New Construction 07/21/2011 $989.02 Class of Work: NEW 12% State Surcharge - Building 07/21/2011 $118.68 Dwelling Units: 0 Plan Review 06/28/2011 $642.86 Stories: 1 Height: 0 ft Plan Review - Fire Life Safety 06/28/2011 $395.61 Bedrooms: 0 Bathrooms: 1 DC Provision Review, COM New - Bldg 07/21/2011 $129.00 Value: $140,000 DC Provision Review, COM New - LRP 07/21/2011 $38.00 Info Process /Archiving - Lg Sheet (over 07/21/2011 $40.00 11x17) Floor Areas: Info Process /Archiving - Sm Sheet (up to 07/21/2011 $5.50 11x17) Total Area: 446 Erosion Control 07/21/2011 $64.00 Accessory Struct: 0 Erosion Plan Review CWS 07/21/2011 $20.80 Basement: 0 Erosion Plan Review COT 07/21/2011 $20.80 Carport: 0 Metro Const. Excise Tax - Commercial 07/21/2011 $168.00 Covered Porch: 0 Use Deck: 0 Tig -Tual School CET - Non Residential 07/21/2011 $236.38 Park - Commercial and Industrial 07/21/2011 $481.00 Garage: 0 TDT - Transportation Development Tax 07/21/2011 $5,622.00 Mezzanine: 0 Total $8,971.65 Required: Required Items and Reports (Conditions) Fire Sprinkler: No Parapet: No 1 Ersn Cntrl 681 -4444 Fire Alarm: No Protected Corridors: No Smoke Detectors: No Manual Pull Stations: No Accessible Parking: 2 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 wit 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: - .1 :. 9.4175 by 7:00 a.m. for the next available inspec date. This permit card shall be kept in a conspicuous place on the job site until mpletion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Commercial (1C�..t6 1 , FOR OFFICE USE ONLY ` „ City of Tigard Date Received J $ ii Permit No. 6(110,0107/-00/4/0 13125 SW Hall Blvd., Tigard, OR 97p, , A Q O Plan Review Phone: 503.718.2439 Fax: 503.59 2 2011 Date/B : �N uL 1 Other Permit: 1 i w: / aegt - TIGARD Inspection Line: 503.639.4175 Date Ready /gg / Juts ® See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Not i ( 0 t l 11 0 Supplemental Information r TYPE OF WORK I R E p UIR D DATA: 1- AND 2- FAMILY DWELLING Da New construction ❑ Demolition Permit fees are based on the value of the work performed. Indicate the value (romded 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. ❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: . $ El Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: ! S 2 90 S V P' ) b,i v New dwelling area: square feet City /State /ZIP: 'Ti , ` 9/2 4'7 ,g ; bf Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: (' /q£ k foc k- Covered porch area square feet Cross street/directions to job site: 5 (A/ pacl6/ c /- /t9% wer, a F Deck area: square feet s A/Q e e f f 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.: 2 S!! Q 0 /3 / 0 1 W0 Indicate the value (romded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. 5c1 oe fir' I:Or; cal arfiie Fhrk Valuation: $ i &it, ©©© 0p Co f e°rr bpi/ Idinf Existing building area square feet / New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: in w f r9frg' /16 Type of construction: Address: 101/0 Ji,/ 4/'ff7 ufhe Occupancy groups: City /State /ZIP: • w.,'7"• / = ' -'' / SG(t / r F/ 1 t� " 7 Existing: Phone: ( WY) 711 - 0,- Fax: ( ) ! p ilg'/ 4 97ij) New: ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* . (Please refer to fee schedule) Business name: /ac /- Rock CPf(rr i9 � r /� Structural plan review fee (or deposit): Contact name: J rl- C e 1A rN FLS plan review fee (if applicable): Address: 79 2 N $'(t/ ice /f0 c f, — City/State /ZIP: r'pp/- s i ! U' g 9 72 2 (-7 Total fees due upon application: Phone: (SOY) 3q7_ fieg Fax:: ( ) Amount received: E -mail: jail, ' l rr f ho finori . /- eO'� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR. roof -top mounted PhotoVoltaic Solar Panel System. Business name: f QS j�LAhf Submit two (2) sets of roof plan with connection details �� and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City /State /ZIP: Permit fee (includes plan review $180.00 and administrative fees): Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60 CCB lic.: Total fee due upon application: $201.60 Authorized signature: ` Oilf This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB) • . . . . 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 03/03/2011 Building Division Plan Submittal Requirements TIGARD 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. I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011 v. Building Division Plan Submittal Requirement Matrix T IGARD Commercial & Multi- Family - New, Additions or Alterations Type of Submittal # of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 3 (site plan required showing location and square footage of all buildings to be demolished) Site Work 3 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 3 Fire Protection System 3 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), if applicable. I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011 • •IN II Building Division (� Development Code Provision Review TIGARD Commercial Projects with Approved Land Use Building Permit No.: �t-x- f a0 ( I-00 / 4D Land Use Casefile No.: Pr)(L Rol l - OC>UO2 Routed Plans: Submittal Date: Submittal Date: Submittal Date: To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (V) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. STAFF: please only mark those items on the left side that are approved. Planning Review (contact i (1 at 503 - 718 - 02 4 3 7 or Cil.rtf/ G @ tigard- or.gov) Land Use Approval - PPR U -0000/ ri /la � .7/!alt/ I '.� /1 0 f G /e d. Building Plans Match Approved Plan: Yes No ❑ Maximum Building Height 35 ' 0 Conditions Met Notes: e o cla; '\ ( - l C s ft 6; 4-, on 3 .7 0 be e.s /c 101;s he el a". d i z Pvt>kd b bdih. pre ice w t?i-11 a.rb '1;34 ('an d i U4f �.L5 Q■C o et o /1 r ��i1 Original Plan: Approved Not Approved 0 Date: 7/// / - a pp. h of i - i i a-1 Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) Actual Slope: t ❑ PFI Permit # ..Er Conditions Met Notes: Original Plan: Approved.. Not Approved ❑ Date: I Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) I Street Trees Protected Trees Notes: Original Plan: Approved Not Approved ❑ Date: 7 P',,lo1I Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) ❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit ❑ Engineering Okay to Issue Permit Notes: Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: YeZr3 No ❑ j Date Routed to Building: • • , Page 2 of 2 ''' ing Permit Application ommercial ( �k L g , ':, FOR OFFICE USE ONLY / L Y Eta ` ®, City of Tigard � D ate B y � Cd/ Ag ' ri, Permit N o. ACIl AW--M/4/0 " 13125 SW Hall Blvd., Tigard, OR 9722„ € a Plan Review I Phone: 503.718.2439 Fax: 503.59 &i fa w Date /By: Other Permit: . TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: 9J See Page 2 for Internet: www.tigard - or.gov CM,' ,' k TiGARID Notified/Method: Supplemental Information k? UF!.d)iNIe prAsiom 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: $ ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 1 S O St/ pa i4 C 79,h G,,,k % i New dwelling area: square feet T j City /State /ZIP: o ,,t( ` (?2 A' ',2,g 6.j Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: IJ /44 ty 0ck-- Covered porch area: square feet Cross street/directions to job site: 5° /j I-,1 t � toe"f j a )% f` Deck area: square feet S IV Alt e t:° e 51- Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. S/ `(� 0/5 / y C ��� Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: �5 ! equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. /3/^ r �, �� / J Valuation: $ ( 4- /1 1 OM. I/O Co r Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: • Name: m i- F l r9gg,Gj /4 c Type of construction: Address: 7 . —_�.- - 169 HO O ,f E,/ ,`�/i 4/P69J r Occupancy groups: City /State /ZIP: ' , „...,--;,,. / fr -- --=y -- J 5 1 * -- Existing: Phone: (sr3) 7'-( - (2S .r �' Fax: ( < ) pcyile, '� 97L New: ❑ APPLICANT D. CONTACT PERSON 'BUILDING PERMIT FEES* Business name: `� /C -'(/r / o I co frt.,- review fee (or deposit): osit): W S tructural plan revie fee (or deposit): Contact name: '7 lei :A ei., FLS plan review fee (if applicable): Address: 79 2 S ic /fa e • I. Cit /State /ZIP: l Total fees due upon application: y Ti 9, r Gf , a 87 / Amount received: Phone: (SO) 3c f7_ l g Fax:: ( ) . PHOTOVOLTAIC SOLAR-PANEL SYSTEM FEES* E -mail: UJI, l es h ere ho fiissr1' /.. co/41 Commercial and residential prescriptive installation of CONTRACTOR . roof -top mounted PhotoVoltaic Solar Panel System. Business name: fp Qs, ��,;G`1h1 Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City /State /ZIP: Permit fee (includes plan review $180.00 and administrative fees): Phone: ( ) ( ) Fax: State surcharge (12% of permit fee): $21.60 CCB lie.: Total fee due upon application: $201.60 Authorized signature: ( U" This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11/02 /COM/WEB) 1 wilding Permit Application Site Work FOR OFFICE USE ONLY /4. � �� t % ? .� Received City of Tigard � � 4 � Date/By: � . / „� PermitNo.:���� / /°° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' ° Phone: 503.718.2439 Fax: 503.598.1960 JUN 2 g � Date/B Other Permit: l'IGARD Inspection Line: 503.639.4175 S " 3 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov rya 7 Notified/Method: Supplemental Information C pp 1Y OFT1G1ARD TYPE OF PAJAPINq DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING 5 New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rotnded 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. El 1- and 2- family dwelling Valuation: $ ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: ['Master builder I=1 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: J s °2 9' 5 1,40' P L /i, i way New dwelling area: square feet J City /State /ZIP: riG1C(!'47 / 0 R q7 '' a Garage /carport area: square feet Suite/bldg. /apt. no.: J . Project name: m /- R fr Covered porch area square feet Cross street/directions to job site: S ij l P �fr e: g,-- 1 --hoh I4 v /2 /4".. Deck area: square feet 5 i,i I.L Noe � &. / e St 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.: S �l 0 �� / r ��� Indicate the value (rotnded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK - work indicated on this application. Valuation: p C $� )0 c�r �tf;,�y Pay /� r . in.5•i /;451 i /fe I,y141 - ,�y ✓ Existing building area square feet Ci4rb aid L,'n /CIpI�� S New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: m t'J f riyata L G C Type of construction: Address: /0/ /O J /V 4/ ;in j u f : A sip r - c P 1 Occupancy groups: City /State /ZIP: Po / - /anI E 0 Je '17 '2 Existing: Phone: ( 33 ) 74.'7.. 05-51 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: d3 /ac k Rock C pp e All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board f41, •f,n C e°f It et under ORS 701 and may be required to be licensed in the Address: 2 1/ v performed. If the S �✓ (�Cl,�e� L f jurisdiction in which work is bein gp / r, applicant is exempt from licensing, the following reasons City /State /ZIP: r/( /,/d7 / c9/e q? 2 f apply: Phone: (so) 3 if _ Gp ry Fax :: ( ) E -mail: it-S �t b1 /t" '� c/ '" e he ii- pi�`1 ‘e., j'P7 f • � J CONTRACTOR Business name: Jame dJ Ap pi i cim f BUILDING PERMIT TEES* Address: (Please refer to•fee schedule) City /State /ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lio : 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: Date: * Fee methodology set by Tri- County Building Industry Service Board. 1:\Building\Permits\SIT-PeimitApp.doc 10/01/09 440 4613T(1I/02 /COM/WEB)