Permit CITY OF TIGARD SITE WORK PERMIT
111 s COMMUNITY DEVELOPMENT Permit #: SIT2012 -00016
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 2S 101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Triangle Pointe Subdivision: VARNS ACRES Lot: 9
Project Description: Installation of concrete pad for HVAC unit.
Contractor: SD DEACON CORP OF OREGON Owner: TRIANGLE POINTE LLC
901 NE GLISAN ST SUITE 100 901 NE GLISAN ST, #100
PORTLAND, OR 97232 PORTLAND, OR 97232
PHONE: 503 - 297 -8791 PHONE:
FAX: 503- 297 -8997
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 08/30/2012 $231.32
Plan Review 08/30/2012 $150.36
Type of Use: COM 12% State Surcharge - Building 08/30/2012 $27.76
Class of Work: OTR Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $6.50
11x17)
Project Valuation: $15,000.00
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: No
Landscaping: Yes Site Prep: No
Storn Drains: No Retaining Wall: No
Fire Underground: No Accessible Parking: No
Fence: Yes
Total $415.94
Required Items and Reports (Conditions)
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 the 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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ®�/
Issued By: O1/l//� r or Permittee Signature: /��4 to � ,C/i , ji
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.
"i#uilding Permit Application
Cantinereiat d0 - `L �� L FOR OFFICE USE ONLY
City of Tigard 21 2ot2 Dat Received eB : o C( ��� PermitNo.: , 4 .4....& 1 64 4 1 ,
a 13125 SW Hall Blvd., Tigard,OR 97 Plan Review T4PM MIN Other Permit: �_ �
Phone: 503.718.2439 Fax: 503.5 INTIGARD DateB : AefLfJr4 •
T I G A R D Inspection Line: 503.639.4175 C t}� Date Rea. tuns: El See Page 2 for
Internet: www.tigard - or.gov BO�DT GDNISIO' . ..Notified/Method: : • P 9 // , _ F r Supplemental Information
mu . � L ' / I ' _ /' ° ■ i .
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
•
❑ New construction ❑ Demolition Permit fees* are based on the valve of the work performed.
Indicate the value (rounded to the nearest dollar) of all
V i 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 V 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: 13, (.. j V - - New dwelling area: square feet
City /State /ZIP: A 4 , , ,. rd ° � Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Avurd TIC chair a-1 Covered porch area square feet
Cross street/directions to job site: f l 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 application.
Valuation: $
0.0.3 C�, -Tf- GdLA rag F�w2>: �oErv/2 ( , �D
Existing building area 1 061D square feet
New building area: (45 square feet
to PROPERTY OWNER ❑ TENANT Number of stories:
Name: ¶ti n6k p L�.L Type of construction:
Y i& Address: , �� `„� fh Occupancy groups:
City /State /ZIP: t r 4 A4` ( a 6 11 Existing:
Phone: (GCS) V41 ,Lt ( Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
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: PHOTOVOLTAIC SOLAR PANEL SYSTE■ FEES*
CONTRACTOR Commercial and residential prescriptive ins : lation of
roof -top mounted PhotoVoltaic Solar P. System.
Business name: q) Submit two (2) s • of roof plan with c- ection details
and fire department . • ess, along the 2010 Oregon
Address: t i7 t_ a- 5q 0 Solar Installation Ssecia ode ecklist.
i
City /State /ZIP: 1�1 Ahd ( ����/n� - - n 11a2"J� � Permit fee (includes pl?
$180.00
and adminis.:.ve fees .
Phone: (5E7.93 tt' r 8111 Fax: ( ■) 5 Ben-7 State surcharge (12% permit fee): $21.60
CCB lic.: I . .11 Total fee d - upon application: $201.60
Authorized signature: / / / / (��� This permit ap . ication expires if a permit is not obtained
�`� 1 t within 180 days after it has been accepted as complete.
Print name: y/e ;�, }�, . I� ' Fee methodology set by Tri- County Building Industry
r t`"r • Service Board
1:\Building \Permits\BUP -COM PermitApp.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): $
•
•
I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
I N o B uilding Division
Development, Code Provision Review
T I G A R D Commercial Projects with Approved Land Use
Building Permit No.: 5 IT le /2- o ° ° %6
Land Use Casefile No.: PI rnb 2b 12-- d Op / 7
Routed Plans:
Submittal Date: 9/ 1 /L
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 (/) 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 eft ide that are approved.
Planning Review (contact at 503-718-2,Y2% or __�� @tigard- or.gov)
Ind Use Approval
❑ Building Plans Match Approved Plan: Yes No ❑
❑ Maximum Building Height w A
❑ Conditions Met ,
_ � O f4, 6 �t ti / / Sr /
Notes: / -t 7� /l
fw.
/
Original Plan: Approved 2' Not Approved ❑ Date: /Zp /h.
v ❑ Date:
`
Re
Revision 1: Approved ❑ Not Appro
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: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ 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 Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ . Date:.
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Planning Okay to Issue Permit ❑ Arborist Okay tR 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 Applicant
Okay to Issue Permit: Yes ❑ No ❑ •
Date Routed to Building:
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Page 2 of 2
CITY OF TIGARD SITE WORK PERMIT
111 s COMMUNITY DEVELOPMENT Permit #: SIT2012 -00016
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 2S 101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Triangle Pointe Subdivision: VARNS ACRES Lot: 9
Project Description: Installation of concrete pad for HVAC unit.
Contractor: SD DEACON CORP OF OREGON Owner: TRIANGLE POINTE LLC
901 NE GLISAN ST SUITE 100 901 NE GLISAN ST, #100
PORTLAND, OR 97232 PORTLAND, OR 97232
PHONE: 503 - 297 -8791 PHONE:
FAX: 503- 297 -8997
FEES
Description Date Amount
Specifics: Permit Fee - Site Work 08/30/2012 $231.32
Plan Review 08/30/2012 $150.36
Type of Use: COM 12% State Surcharge - Building 08/30/2012 $27.76
Class of Work: OTR Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $6.50
11x17)
Project Valuation: $15,000.00
Site Specifics:
Excavation Volume: cu. yd.
Fill Volume: cu. yd.
Impervious Surface: sq. ft.
Engineered Fill: No Soil Report Required: No
Paving: Yes Grading: No
Landscaping: Yes Site Prep: No
Storn Drains: No Retaining Wall: No
Fire Underground: No Accessible Parking: No
Fence: Yes
Total $415.94
Required Items and Reports (Conditions)
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 the 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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ®�/
Issued By: O1/l//� r or Permittee Signature: /��4 to � ,C/i , ji
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.
IN Building Division
Development Code Provision Review
T I G n R D Commercial Projects with Approved Land Use
Building Permit No.: (a•-C,9O/
Land Use Casefile No.: t M 6Q/ — Ocz)/ ?
Routed Plans:
Submittal Date. A( l 9
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 hsted 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 J at 503 -718- 2M or @tigard - or.gov)
Land Use Approval
Building Plans Match Approved Plan: Yes No ❑
„J;V ifaximum Building Height
ditions Met w
Notes A./ rl
Original Plan Approved Not Approved ❑ Date r . 7 • (Z-
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)
.a Actual Slope V t % 22.- 7 .,
❑ PFI Permit #
❑ Conditions Met
Notes:
Original Plan Approved J Not Approved ❑ Date s (315/I
Revision 1• Approved ❑ Not Approved ❑ 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 Approved ❑ Date
Revision 1: Approved ❑ Not Approved ❑ Date
Revision 2: Approved ❑ Not Approved ❑ Date
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard -or gov)
❑ Planning Okay to Issue Permit ❑ Arbonst Okay to,Issue Permit
'❑ Engineering Okay to Issue Permit
Notes
Original Plan: Date Sent to Applicant
Revision 1: Date Sent to Apphcant
Revision 2 Date Sent to Apphcant
Okay to Issue Permit Yes y o ❑
Date Routed to Building
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• Page 2 of 2