Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2012 -00167
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/22/2012
Parcel: 2S 111 AA00401
Jurisdiction: Tigard
Site address: 14145 SW HALL BLVD
Project: Hall Blvd Baptist Church Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 63
Project Description: Fire barrier repair due to water damage.
Contractor: KENNEDY RESTORATION Owner: HALL BOULEVARD BAPTIST
315 SE 7TH AVE CHURCH
PORTLAND, OR 97214 PO BOX 230130
TIGARD, OR 97223
PHONE: 503 - 234 -0509 PHONE:
FAX: 503 - 234 -4479
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Vg Permit Fee - Additions, Alterations, 08/22/2012 $53.27
Demolition
Occupancy Grp: A -3 Occupancy Load: 12% State Surcharge - Building 08/22/2012 $6.39
Dwelling Units: 0 Plan Review 08/22/2012 $34.63
Stories: 2 Height: 0 ft Plan Review - Fire Life Safety 08/22/2012 $21.31
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Sm $0.50 (up to 08/22/2012 $1.50
Value: $300 11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $117.10
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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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 ' • . -• • - • e 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. • TTENTION: Ore. •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 101 -0010 through OAR 9' - 001 -0. -'. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. .44.
is ued By: / . /, Permittee Signature: //�i �a
\ , L�lf�
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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.
liildin2 Permit Application 104
Commercial C.�;�TE el- er06'r FOR OFFIcy 1,si: ( i .1
City of Tigard [jj G I r' Date/I3 S 0-' /9' . . Permit No.: p� , /s -AO /6
11,4 • 1312 SW Hall 2439' Faa1¢,IjR 3 Z S 1 CAI_. .
Ill Phone: 503.718.24 a�xGG yggg3.4 960 �r r _, i! • cc Permit:
Inspection 9 � .I �v�►
T 1 G \ R u p d IG D, ?�v� " ' a ReadyBy: • Juris: ® See Page 2 for
Internet: www. Not Supplemental Information
BUILDING J MvrsJON
TYPE OF WORK REQUIRED DATA: l- AND 2 -FAI LILY 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.
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❑ 1- and 2- family dwelling l 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: / lit LIT S W 114 LL gLV b New dwelling area: square feet
City/State /ZIP: 7' 1641ez i 012 9 7 7_7,_q Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: L4 j f3LV D. MeT�,5 T Covered porch area square feet
Cross street/directions to job site: 5 O Lir/4 O4 1/41.2. peom Deck area: square feet
Ev/L- D1NC, Deter. /1 X I /14l LC 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.
T- '»i a T) Fixc &44,ei 72 Valuation: $ p�
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP:
Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT Z. CONTACT PERSON BUILDING PERMIT FEES*
� �#V Ev s ( 7 3i2L4-Y7D (Please refer to fee schedule)
Business name: Structural plan review fee (or deposit):
,, //
Contact name: A/(4 Y
Address: 3/5 s E 7Tlt<- Ave- FLS plan review fee (if applicable):
City/State /ZIP: PAX
Total fees due upon application:
Phone: ( 9S6 - 306 / Fax: : ( ) '
Amount received:
E -mail: 414 f hew A @p tolt� `� Go"-, PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
J re . 5". Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: ICe-AmiE-b y gc._.sTa/e/,:w7 0AI Submit two (2) sets of roof plan with connection details
3/S S E �{. and fire department access, along with the 2010 Oregon
Address: 7T f/� Solar Installation Specialty Code checklist.
City/State /ZIP: �per j) e 7 724 t i Permit fee (includes plan review $180.00
/ t� and administrative fees):
Phone: (Z3) Z 3 y - Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: Q I aee, _ Total 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.
Print name: /$44.77 y Date: If ZZ.- 20/ Z ` Fee methodology set by Tri -County Building Industry
Service Board
1: 1Building\Permits'BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11 /02 /COM/WEB)
I PIII
e . Building Division
Over - The - Counter (OTC) Building Permit
T I G A R D Check List
Project Description: 71
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APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: MBE Occu.anc Grou.: M j ' Type of Construction: ".
*Type of Use: Air Occupancy Load: Oregon Specialty Code:
SPECIFICS
Number of Stories: °r 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 �� r
Fire Sprinklers: Ili ) Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ '30CD FEES DUE
$ DC Prov Rvw, COM TI - Ping
$ DC Prov Rvw, COM TI - LRP
DC Provision Review Fee for COM TI $ ', — Permit Fee - Add, Alt, Demo
Project Valuation Planning LRP $ .12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 3.4-, (o J Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ "Z t , ' Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ 1 , `DO 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: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ l (( 10 TOTAL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; END = foundation; DIM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies);
REP = repair.
I: \ Building \ Forms \OTC - BUP.docx 07/01/2012