Permit s
CITY OF TI GARD BUILDING PERMIT
PERMIT #: BUP2002 -00030
41 DEVELOPMENT SERVICES DATE ISSUED: 10/21/03
� - - I ' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 08530 SW PFAFFLE ST PARCEL: 1S135DA -01000
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT: 020 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: a 5 000
Remarks: Modify existing residential structure for change of use.
Owner: Contractor:
DAVE DALTON
17930 SW MCEWAN
TUALATIN, OR 97062
Phone: 503 - 267 -4419
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Framing Insp Misc. Inspection
[BUPPLN] Pin Rv 2/4/02 $53.11 Framing Insp Final Inspection
[FLS] FLS Pin Rv 2/4/02 $32.68 Insulation Insp Final Inspection
Shear Wall Insp
[TIF -C] TIF - Commerc 10/21/03 $2,316.00 Shear Wall Insp
[TIF -MT] TIF Mass Tr 10/21/03 $986.00 Gyp Board Insp
(additional fees not listed here) Gyp Board Insp
Bolts in concrete final repot
Total $4,313.73 Bolts in concrete final repot
Structural observ. final repr
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 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 than 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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: 4 Ge∎ (-4e-
Permittee / 'ta /%C
Signature: 7 I
Call 639 -4175 by 7 p.m. for an inspection the next business day
. • • Building PaiRE6 1 r 1 I i. % : !. n
�) ,.t I '1' Date received: D R Permit no.: ?n
AU City of Tigard 0
'-- .EB - 2002 Project/appl. no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, igard, O 972
Phone: (503) 639 -4171 CITY OF Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 BUILDING DIVISION Case file no.: Payment type:
Land use approval: 6121 2. 2001 —&004 l &2 family: Simple Complex:
TYPE OF PERMIT
O I & 2 family dwelling or accessory O�ommercial/industrial O Multi- family O New construction O Demolition
O Addition/alteration /replacement Si Tenant improvement O Fire sprinkler /alarm • « GHAN( Op c W 1 PAH` C
JOB SITE INFORMATION
Job address: sea i 6.14. PP. fr . co r. - '1'l . - • • , • Bldg. no.: Suite no.: '
Lot: Block: Subdivision: Tax map /tax lot/account no.: 1513 0A 100D
P . ect name: DprI,TON C.P. E.0
Description and location of work on premises/special conditions: u • tr •X A - - •'E Tli4 • G
'V' H .t D' .. -Pa • ;,_I • . _ .. , A< 1D. ' - i e.', •• O • - __ - LT
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: D Yi.b 0 ¶014 (Floodplaiii, septic capacit v, solar, etc.) .
Mailing address: 179 p to.W• MGE ty 79 • 1 & 2 family dwelling:
City: u 1.16 l State:p- ZIP: 4 47 - V Valuation of work $
Phone: , - Fax: E -mail: No. of bedrooms/baths
Owner's representative: D&'J 10 DM.X014 Total number of floors
“tt.i, Phone. • -441' Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Covered porch area (sq. ft.)
Name: 1 LO J t-.14 . 1 . 'A Covered
area (sq. ft.)
Mailing address: - ,_,� - .
City: State: ZIP: Other structure area (sq. ft.) ,
Phone: Fax: E -mail: Commercial/industrial /multi- family: Z pew —
CON71(ACTOR Valuation of work
EEET Existing bldg. area (sq. ft.) 1 BP Qy
New bldg. area (sq. ft.) ------
Address:
City: State: ZIP: Number of stories 2 py Ye 130ereit : ht
Phone: Fax: E-mail: Type of construction V
CCB no.: Occupancy group(s): Existing: 1t. - 3
New: re,
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITEC IDLSICNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: ' exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
CM Contact person ,k : ;.„„, _ ,, Fees due upon application $
Address: ft . . , 4. Date received:
StatebE ZIP: 91 _ Amount received $
Phortgb34 • - , E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard
v rlvgl ctif lied with, whether specified herein or not, To effor Credit card number: Expires
Authorized sign 4A O.mg 44t.LA l,/ Date: Z•A^•DZ Name of cardholder as shown on credit card
Print name: a)%I.4 A. 1 PGWh $
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6ro0ICOM)
Ji 6 ;::, IP cS7 i5 71
J
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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 plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
S = Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
B (New, Add or Alt) 1* B = Building
F (New, Add or Alt) 3 ** F = Fire Protection System
M (New, Add or Alt) 2 • M = Mechanical
P (New, Add or Alt) 2 P = Plumbing
(New, Add, or Alt) 2 E = Electrical
New = New Building
Add = Addition
Alt = Alteration to existing
building
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level "3" technicians.
I:\dsts \forms\matrxcom.doc 10/27/00
.
DATE: . S _ O fists( C r E d N OS - Q 00 30
PROJECT TITLE:
COUNTYWIDE Da L 's e,„,zr�,-,•
TRAFFIC IMPACT FEE
WORKSHEET AP LICAN
(FOR NON - SINGLE FAMILY USES) MAILING ADDREP,,,(/ ligek
CITY/ZIP/PHONE 7 G «erd g72g/ 4)-o- 208t0
TAX MAP NO.: V �J }
/000
SITES NO.A -
LAND USE CATEGORY RATE PER TRIP g 53 o S ?44 -1-+ Ie- S
RESIDENTIAL $ 253.00
A BUSINESS AND COMMERCIAL $-6416 5 /.0
OFFICE $ 233.00
INDUSTRIAL $ 244.00 �
INSTITUTIONAL $ 105.00 C red; �� U e41 - f J 1� farm • y
m er (( Se--
PAYMENT METHOD: a 6 resi cJ,Py(c 7 #i -v pr 0 / CA/4J
CASH/CHECK
CREDIT
BANCROFT (PROMISSORY NOTE)
INSTITUTIONAL ONLY:
DEFER TO OCCUPANCY LAND SE ATEGORY �QE-S IPT
CRION US WEEKDAY d WEEKEND AVG. TRIP RATE
ee . Q t.� i � TRIP KD RATE
�Q.IO d I �--
BASIS: 4pp c!n4 P r
t'D ase � o �t.Se o1M r'e5 4 o
f 8e OA CAfrir�� bus mess.
CALCULATIONS:
7 - w Guev 1a +rz ra - Cred;4 - Par . - Cw - h. e -1 4rp ra �C
r ®P'+' - {Y -, P
1 i = (o. 4'- io) .88t� ,c 57.00
3o -b8 .88 A $51 = $ 3, 30. 00
PROJECT TRIP GENERATION:
S$
FED
FOR P ACC SUNTING PURPOSES ONLY
ADDITIONAL NOTES:
ROAD ApLT.:.. I / O 0
TRANSITS/III O G P . O O
PREPARED E
•
August 6, 2003 hi�i;�
CITY OF TIGAR®
Jim Andrews OREGON
Nicoli Engineering
PO Box 23784
Tigard, OR 97281
TRAFFIC IMPACT FEE FOR DALTON'S CATERING — 8530 SW PFAFFLE ST.
Enclosed with this letter you will find a calculation sheet showing the computation that has
been performed to determine the amount of the Traffic Impact Fee (TIF) to be paid for the
project noted above. The amount of the TIF is $3,302.00.
You have two payment options available to you. The first is to pay the TIF at the time you
are issued a building permit. The second is to arrange for payment over time by signing a
promissory note (if you wish to exercise this second option please contact me for additional
details).
Please note that you may appeal the discretionary decisions made in determining the
appropriate category and the amount of the fee based on that category. A notice of appeal
must be received by the City Recorder no later than 5:00 p.m. on August 20, 2003 and must
be accompanied by the $1,170.00 appeal fee required by Washington County. Although
filed with the City Recorder, an appeal would be heard by the Washington County Hearings
Officer.
Also enclosed with this letter, you will find a "Countywide Traffic Impact Fee Payment Option
Form ". Please choose a payment option, obtain necessary signatures, and return to me as
soon as possible. We must receive this form before permits can be issued.
If you have any questions, please contact me at 639 -4171.
r ee Gaynor
Ex cutive Assist
k
Enclosures (2)
c: TIF file
Building file
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 I = UP .
Received Date Requested S / I AM PM BUP
Location RS 3 Jp l Qy Suite c MEC
Contact Person k _ Ph ( ) 3 / 7°Z 1 PLM
Contractor Ph ( ) 2 7 y '//? SWR
UILD Tenant/Owner 419-69 S2- A ELC
ing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
lla�'
- S PART FAIL
= ING
'ost & Beam
nder Slab
Hugh -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date / b Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL