Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2012 -00125
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2012
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 140
Project: House of Bread Subdivision: 2004 -015 PARTITION PLAT Lot: 2
Project Description: TI
Contractor: BLACK DIAMOND HOMES INC Owner: SN PROPERTIES PARTNERSHIP
15685 SW 116TH AVE SUITE 290 1121 SW SALMON ST
TIGARD, OR 97224 PORTLAND, OR 97205
PHONE: 503 - 201 -6304 PHONE:
FAX: 503 - 579 -3990
FEES
Specifics: Description Date Amount
Type of Use: COM DC Provision Review, COM TI - Ping 06/26/2012 $64.00
Class of Work: ALT DC Provision Review, COM TI - LRP 06/26/2012 $9.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 06/26/2012 $453.95
Stories: 1 Height: 0 ft Demolition
Bedrooms: 0 Bathrooms: 0 12% State Surcharge - Building 06/26/2012 $54.47
Value: $25,000 Plan Review 06/26/2012 $295.07
Plan Review - Fire Life Safety 06/26/2012 $181.58
Info Process /Archiving - Lg $2.00 (over 06/26/2012 $8.00
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,066.07
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes 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 '• =.r •r•ance 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 • TTENTION: Oregon aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 001 -0010 through OAR 952 .01 -• !0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I ued By: / /if Permittee Signature: / / /''
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. fr.4" M.
This permit card shall be kept in a conspicuous place on the job site until completion o , e project.
Approved plans are required on the Job site at the time of each Inspection.
Building Permit Application
r.ap A�
Commercial i �� / ) FOR OFFICE USE ONLY
City of Tigard
` = DateB d `r '��/I I / (2.40 a_ Dat
° 13125 SW Hall Blvd., Tigard, OR 9722 IN 2 6 201 Plan Revi r�.�
11111 °
Phone: 503.718.2439 Fax: 503.598.1 eB : �' ' / / Ezi
T I GA R D Inspection Line: 503.639.4175 Date Ready :y. luris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIG RD Notified/Method: Supplemental Information
F3Ull ]I'iO I)pV lftN
TYPE OF WORK REQUIRED DATA: I- 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.
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $ ,
❑ 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: 16230 SW Pacific Hwy #140 New dwelling area: square feet
City /State/ZIP: Tigard, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 140 Project name: House of Bread Covered porch area: square feet
Cross street/directions to job site: 99w and Durham St. Deck area: square feet
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.: 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.
TI - walls and finish for a bakery Valuation $ DS
Existing building area: 2098 square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: House of Bread Type of construction: Commercial TI
Address: 14930 SW Brooklet P1. Occupancy groups:
City /State /ZIP: Tigard, OR 97224 Existing:
Phone: (503)475 -9702 Fax: ( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: Black Diamond Homes, Inc. (Please refer ro fee schedule)
Structural plan review fee (or deposit):
Contact namc: Jeff Bettinelli
FLS plan review fee (if applicable):
Address: 15685 SW 116 Ave., Suiet 290
City/State/ZIP: fees due upon application:
ity /State /ZIP: Tigard, OR 97224
Phone: (503) 201 -6304 Fax: : (503) 579-3990
Amount received:
E -mail: Blackdiamondhomes @comcast.net PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: Black Diamond Homes, Inc. Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 15685 SW 116th Ave., Suiet 290 Solar Installation Specialty Code checklist.
City /State /ZIP: Tigard, OR 97224 Permit fee (includes plan review $180.00
and administrative fees):
Phone: (503) 201 -6304 Fax: (503) 579 -3990 State surcharge (12% of permit fee): $21.60
CCB lic.: 109542 Total fee due upon application: $201.60
Authorized signature: t • It This permit application expires if a permit is not obtained
1 ( 't� �, within 180 days after it has been accepted as complete.
Print name: Jeff Bettinel Date: 6/26/1
* Fee methodology set by Tri County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PerrnitApp.doc 02/24/2011 440- 4613T(I 1/02 /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: [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): $
1: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
Building Division
:11
Plan Submittal Requirements
T I G A R D 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 El 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
II a Building Division
e..
Plan Submittal Requirement Matrix
T I G A R D Commercial & Multi - Family - New, Additions or Alterations
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(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
I N
II Building Division
Development Code Provision Review
T I G A It D Commercial Projects - No Associated Land Use Case
Building Permit No: � (- " -06/095 I - xpedited Review
Plan Submittal Date: la/�- !v / /,.)_ / -_ ,/
To the Applicant: l Mfd S W kl e 44 / 01 5 v
> 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.
Planning Review (contact / at 503 - 718- '/Y'Dor 4 @ tigard- or.gov)
8 Zoning e- Permitted Use Yes 111- ❑
L►T Land Use Required: Yes ❑ No (explain below)
t
Notes: C /� (/� 7 14-211 - 4 .1'<1.
. 04Prf
►/v dd, y //1 ,,,
/Approved ❑ Not Approved Date: Z -���2—
mil-/
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date:
I: \CURPLN
I LI Building Division
T 1 G A R D Over - The - Counter (OTC) Building Permit
Check List
Project Description: T(
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Nt.T _ Occupancy Group: j Type of Construction: '
*Type of Use: Occupancy Load: t Oregon Specialty Code: 2010
SPECIFICS
Number of Stories: 1 Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: _ Carport: Mezzanine:
SETBACKS
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: _ W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: (ej Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ '2`710 FEES DUE I
$ 4 , CO DC Prov Rvw, COM TI — Ping
$ " . CO DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 4 '3, ) Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ • 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 2.," . 0' Plan Review, Structural
$5,000 - $74,999 $64.00 $9.00 $ I I , < . Plan Review, Fire Life Safety
$75,000 - $149,999 $160.00 $24.00 $ fl , Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $256.00 $38.00 $ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admin Fee
Permit Coordinator: $ e - :
$ Other:
Building Staff: $ Other:
Date /Time: $ (a(.07 TOTAL EES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORE ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
1: \Building \ Forms \OTC- BUP.docx 01 /13/2011