Permit CITY OF TIGARD BUILDING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: BUP2012 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012 •
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: FRED MEYER Subdivision: Lot:
Project Description: Installation of Blink DC Fast Charger.
Contractor: ELECTRIC TRANSPORTATION ENGINEERING CORP Owner: FRED MEYER INC
430 S 2ND AVE 3800 SE 22ND AVE
PHOENIX, AZ 85003 PORTLAND, OR 97202
PHONE: 602 - 716 -9576 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 05/22/2012 $377.90
Class of Work: OTR Demolition
Dwelling Units: 0 Plan Review 05/02/2012 $245.64
Stories: 0 Height: 0 ft 12% State Surcharge - Building 05/22/2012 $45.35
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Sm $0.50 (up to 05/22/2012 $25.00
Value: $19,098 11x17)
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Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $693.89
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: 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 i - • • • • 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: Oregon -w requi =s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 •01 -0010 thro gh OAR 952 -0r • -r % • 0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
/% .400001. .��
' By: LL�- / � ` Permittee Signature: �� _`
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Call 503.639.4175 by 7:00 a.m. for the next available inspe on 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.
(, ' )3iiilding Permit Application
Commercial R / FOR OFFICE USE OiNLY .
CI of Tigard ti PP e'D Received / Permit No.:
V 'J g Date/B ��� kCt P�1 -obey
13125 SW Hall Blvd., Tigard,OR 97223/IPA:. Plan Review , o
ll Phone: 503.718.2439 Fax: 503.59&4p60 3 2 Date/B : Avvi El= Other Permit: ;yl b AO //_ 4
Inspection Line: 503.639.4175 e (• / Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov � / � � T Notified/Method: �/ � ' Supplemental Information �D,� / G O ,7.1D /(6 Tit"
TYPE OF WORK 16 /QN REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition .Permit fees* are based on the value of the work performed.
Indicate the value ( rotded 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 El m
Commercial/industrial
Valuation: $
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: j I s64* s 14 PeG•FIC„ kat New dwelling area: square feet 1 1
City /State /ZIP: 7'l.D I Oa 412:2•S • Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: F ine Covered porch area square feet ti
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 applicatio
Valuation: S i C f i 0 ( c3
. u esesti n a,T'tAttl sF $1.44K DC arc Crimulelre. 14udl►1Nd
• Existing building area square feet
Gbu c lie u. C stir 1�197NL rAiN0A1 011M arena..,
New building area: square feet
❑ PROPERTY OWNER ❑TENANT Number of stories:
Name: /' p/ 0 5 /4, X/ G C O //k/ Type of construction: . • �' / f Occupancy groups:
City /State /ZIP: X a �� �� 9 r Existing:
P h o n e : ( ) cit -. 8..6/5- d C � " Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
\ 'k''.: . I (Please refer to fee schedule)
Business name: tyl A1w.4R tc,w
+JOt� • Structural plan review fee (or deposit):
Contact name: t j,c4( 16.40 FLS plan review fee (if applicable):
Address: 36B Sv 1 SIT s
Total fees due upon application:
l
City /State/ZIP: F ..TLwa,D 01 41344 I s
Phone: chili / Amount received: ,
( �p3) �{ 13 . I Fal `' ( ) �� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail: v." (3EA 1+1 fl EtoTAL.ITY - Ce.h
CONTRACTOR Commerciallt • residential prescriptive ' • . tallation of
roof -top mount=s 'hotoVoltaic So . anel System.
Business name: GL6(. i TR4-S/'O eT4-77D Ai e- / G /,/E- ,,J (r- Submit two (2) sets . roof plan 1 connection details
�G n
/ 47,„13 and-fire department ac • - ss, all :. with the 2010 Oregon
Address:
Solar Installation Specia • ' ode checklist.
City/State /ZIP: Permit fee (inclu. s • . review $180.00
and ad' mistrati' : fees):
Phone: ( ) Fax: ( ) State surcharg l2 %of permit, fe • $21.60
CCB lie.: put, ;
To fee due upon application: $201.60'
Authorized signature: This permit application expires if a permit is not obtained
- within 180 days after it has been accepted as complete.
• Fee methodology set by Tri -County Building Industry
Print name: p1•att' trek..... Date: 34•1/2. Service Board
I: \Building\Permits\BUP -COM PermitApp.doc 02/24/2011 4404613T(1 I /02 /COM/WEB)
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° Building Division
I ..
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 %).
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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: $
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(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
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TOTAL (shall equal line [2] of Valuation Computation): $
•
I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
re A (4 5/WIGE
0 / rig y 52 r -
11 • ° Building Division J
Development Code Provision Review
TIGARD Commercial Projects with Approved Land Use
Building Permit No.: 6
Land Use Casefile No.: Her) 1t Ae)/ l - ODG 3
Routed Plans:
Submittal Date: g % / /2-
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 (1) 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 _ CaJ/le J at 503- 718 - a4 37 or dicey/ G @ti - or.
❑ Land Use Approval
❑ Building Plans Match Approved Plan: Yes ❑ No ❑
❑ Maximum Building Height
❑ Conditions Met
Notes: etece+ i c. veil; de aka/ inc S�a-lion $ ✓ ere not S ku w ,► o n
onglnal MO pigmy However pMarv.tn{ lri -these_ Joe akon.; dde
2 of rer ; a. lit,d use_ re v ;a
Original Plan: Approved Not Approved ❑ Date: 5- q - (g9.,
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:
❑ PFI Permit #
❑ Conditions Met
Notes:
Original Plan: Appr. - ed ❑ Not Appro d ❑ Date:
Revision 1: = .proved ❑ Not Approve. • 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)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Ap • .. ved ❑ Date:
Revision 1: Approved • Not Appro •d ❑ Date:
Revision 2: Approv- • • Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard- or.go)
❑ 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 Applic. -
Okay to Issue Permit: Yes ❑ • • o ❑
Date Routed to Building:
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