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Permit .Su6 'j //7& , S` /7 /ii ft/o T 2-67//6 imva ty Development 1 2011 • Request for Permit Action AUG 1 T `'� CITY OFTIGA'iD Rill D9 tip' DiViS` .. °^ TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: Owner ❑ Applicant ❑ Contractor 4 City Staff (check one) REFUND OR Name: City Of Tigard Nick Nissen INVOICE TO: (Business or Individual) Mailing Address: 13125 SW.Ha l Blvd City /State /Zip: Tigard Oregon 97223 Phone No.: 503 -6- 718 -2608 PLEASE T ACTION FOR THE ITEM(S) CHECKED ( l t CANCF.I. PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach receipt, if available). (4, , ❑ INVOICE FOR FEES DUE (attach case fee schedule and exp < !. below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). C) Permit #: $3u,.e. .2b 1 t two ? /// // Site Address or Parcel #: 9025 SW Burnhaam Project Name: Zuber, House . _ - Subdivision Nance: Lot #: EXPLANATION: ATION: We have been advised_ by CD that since our use there will be temporary, e ' - ) 4 1. --4 a rye; f cep p � C .t'. �3�:�, w A r` �x � �.. t '- itil 4' 1 I l f / _> � 4: /C 4 �z 4 * Signature: �-�- _ Date: 8/9/2011 Nick Nissen Print Name: 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 fcefor 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. '' ,a'`, �a w � � �� � Rte to S s Admin:. Date $ tt + � '�� Rte to Bli Admin: Date / vAn. B Refund Processed: Date n/ B ;',. Invoice Processed: _ Date B Permit Canceled: Date AIMPA' B 42 ' . cel Ta: Added: Date B Recei i t # Date Metho. Amount $ I: \Building \I �orms\Rcgl'cnnitAction.doc Rev 02/23 /2011 Building Permit Application V 0 I // y „ 40,7 Commercial ! EC EV ED oR oHFICI usE oil �r City of Tigard Received En 1 Permit No.: . I do l/_t F? 13125 SW Hall Blvd., Tigard, OR 9724, A 7 Y 1 2O Plan Review ' 0 : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: C 1 G A RD Inspection Line: 503.639 OF n Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov CITY "; TI 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 El 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 Valuation: $ ❑ Commercial /industrial ❑ Accessory building El Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: g©2_ 5 ice) 13 y 4 i A t?-j1/1 New dwelling area: square feet City /State /ZIP: l 2 R2.3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: r T tnl " `( [',/� � 1 Covered porch area square feet Cross street/directions to job site: Deck area: square feet 1 Other structure area: square feet 1 . 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 (roinded to the nearest dollar) of all _i equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ,v _. _ �-, 5eS Valuation: $ 3 l�L� JC— Existing building area square feet New building area: square feet [PROPERTY OWNER ❑ TENANT Number of stories: Name: L/ /y rip( Z Type of construction: ca Address: / 3/ ZS 5 fit) ijoae es/(Jed Occupancy groups: City /State /ZIP: /y � m g T 7 2_ 2- Existing: Phone: (5223) 7 / " g Z l®O,S Fax: (3 ,_.,i) � I g 4/ 9 New: ` ❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) usiness name: IQ Structural plan review fee (or deposit): Contact name: FLS plan review fee (if applicable): Address: City /State /ZIP: Total fees due upon application: Phone: ( ) Fax: : ( ) Amount received: E -mail: PH t TOVOLTAIC SOLAR PANEL SYSTEM FEES* 00/TRACTOR Commerct.. and residential prescriptive installati / • - roof -top moun >,. PhotoVoltaic Solar Panel - tem. Business n Submit two (2) set >. roof plan with .. nection details and fire department ace= Ion • •ith the 2010 Oregon -- Address: Solar Installation Special '"i> _ ecklist. 1.. Permit fee (inc .. es plan revie r . City /State /ZIP: .. I ministrafive fees): $180.00 �� Phone:( ) Fax: ( ) o 1 n State stir arge (12% of permit fee): $21.60 J CCB lie.: Total fee due upon application: $201.60 Authorized signature: / This permit application expires if a permit is not obtained /C� �/ within 180 days after it has been accepted as complete. Print name: /V/ G - ,v i l $ P"-d Date3 ( �._ // * 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