Permit �T; GAR�D'
;firma
City of Tigard
June 3, 2013
BooCo Construction Inc.
Attn: Tony Kelleher
PO Box 30149
Portland, OR 97294
Re: Permit No. BUP2012 -00205
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15570 SW Pacific Hwy
Project Name: Safeway
Job No.: N/A
Refund Method: ® Check #210236 in the amount of $456.11.
❑ Credit card "return" receipt in the amount of $ .
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $ .
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees
only as plan review was completed.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/ d !.
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
ry!
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: BooCo Construction Inc. DATE: 5/16/13
Attn: Tony Kelleher
PO Box 30149 REQUESTED BY: Dianna Howse
Portland, OR 97294
TRANSACTION INFORMATION:
Receipt #: 188903 Case #: BUP2012 -00205
Date: 10/24/2012 Address /Parcel: 15570 SW Pacific Hwy
Pay Method: Check Project Name: Safeway
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees only as plan
review was completed.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Building Permit Fee 230- 0000 -43104 $407.24
12% State Surcharge 100 - 0000 -24001 48.87
TOTAL REFUND: $456.11
APPROVALS: SIGNATURES /DATE:
If under $5,000 Professional Staff i ice_
If under $12,500 Division Manager
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I 6737/3 By: "
I \Building \ Refunds \RefundRequest.doc x 09/01 /2010
From: 05/15/2013 12:41 #166 P.001/001 (/
05/15/2013 11:53 5035981960 CITY OF TIGARD P 01/01 C
� EIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAY 1 5 2013
N-f. Request Permit Action CITY OF TIGARD
13125 SW Hall Blvd. • Tigard, Oregon 97223 •503.718.2439 • www.ligartai IJcJNG DIVISION
TO: CITY OF TIGARD
Bung Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone 503.718.2430 Fax 503.598.1960 www.tigard or.gov
FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: �
INVOICE TO: (Burrows a lodlvidaal) ld S4' ko -
Mailing Address: P') }��X (`) I L i 1
City /State /zap: Pcx--I) )R q 7Z CJ L)
Phone No.: Z(07 -
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
zr- CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT PEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: is'zc)Iz C7 it)7
Site Address or Parcel #: S U C) C n'a Z (`) C)
ProjectName: C.t4W Cky
Subdivision Name: c f 7 " () I / o '26r-4-416r) P1t t #: >
EXPLANATION: re4 ne.e1 e &
Signature: A Date: ' j -- % - S
Print Name:
Daman*
1. The Director or Ih ildirtR Official may authorial, the refund of:
n) any fee which war aeoncoualy paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended
c) not more than 80% of the hand uac application fcc for issued pcanita.
d) not more than 80% of the btuldinRplan review fcc when an application is canceled before any plan review eff st has ban expended
c) not more than NV% of the buldingpern t fee for issued permits prior to any Inspection requests.
2. Refunds will be returned to the orip)nal Payer in the flame method in which payment was ccaived. Please allow 2.4 weeks for procctring refunds.
I'
Rte to S s Admin: Date gm 10m i, Rte to Bud Admire Date B t►ia -
Reftmd Processed: Date 01/4474 5 _47A21 Invoice Ptocctrxed: Date 1311111111
Permit Canceled: Date
��� /A1116111KEZ arcel Added: Date B
Date Met) o. Amount $
L• \Building Fo nrOc PcsnitAetion.doe Rev 05/25/2012
CITY OF TIGARD BUILDING PERMIT
. < COMMUNITY DEVELOPMENT
Permit #: BUP2012 00205
•
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Pharmacy consultation room modifications
•
Contractor: BOOCO CONSTRUCTION CO Owner: TRC MM LLC
PO BOX 30149 5973 AVENIDA ENCINAS STE 300
PORTLAND, OR 97294 -0835 CARLSBAD, CA 92008
PHONE: 503 - 262 -6570 PHONE:
FAX:
Specifics: FEES •
Description Date Amount •
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review, COM TI - Ping 10/24/2012 $67.00
Occupancy Grp: M Occupancy Load: DC Provision Review, COM TI - LRP 10/24/2012 $10.00
Dwelling Units: 0 12% State Surcharge - Building 10/24/2012 $61.09
Plan Review 10/24/2012 $330.88
Stories: 1 Height: 0 ft Plan Review - Fire Life Safety 10/24/2012 $203.62
Bedrooms: 0. Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 10/24/2012 $2.00
Value: $30,000 11x17)
Info Process /Archiving - Sm $0.50 (up to 10/24/2012 $1.50
11x17)
Floor Areas: Permit Fee - Additions, Alterations, 10/24/2012 $509.05
Demolition
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
•
Total $1,185.14
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 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: Permittee Signature:
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.
•
•
Building Permit Application
ial
Commercial RECEIVE E ONLY
FOR OFFICE US
City of Tigard OCT "" 4;. 2U1 Permit Rece iDate B ved • p��
9o
I ° 131 Hall Blvd., Ti ard, OR 97223 2 : Y c � �
1 Lx[
lg Plan Review
® _ Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD DateB : 1��2
T I G'n RD pp
BUILDING Line: 503.639.4175 �� ��I �urww Date Ready :y: Juris ® See Page 2 for
Internet: www.tigard- or.gov BLDING ( $ Notified/Method: ii 40 Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El New construction 0 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: i 55 5 :.-.) •Mt✓f G I-1 w J New dwelling area: square feet
City /State /ZIP: 1 ,6 p EJ / «,l� / I Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: S f :�. / Covered porch area: square feet
Cross street/directions to job site: / 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.
Valuation: $
reu l�IAr c. �o�+. svaTArir� �Q -t Max Fcta ; c2NS 30 o�U
Existing building area: square feet
New building area: square feet
PROPERTY OWNER . ❑ TENANT Number of stories:
Name: ,11,, :1�� , Type of construction:
Address: )1o3C.b .S E.p., ST—f Occupancy groups:
City /State /ZIP: Gam' — . J4 - 7015' Existing:
Phone: ( 503) 47 7 - $5 10 Fax: (503) 6,57 _ Biv3i0 New:
KI APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: t ja,GO �,,,,s -n2�Yi°`i p7J Lt-1,16. (Plense refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: ''f"p1`1t K(L. t.4 E(.
FLS plan review fee (if applicable):
Address:
7c 5 C ,t - 75 P.
Total fees due upon application:
City /State /ZIP: VQ 4 J...X.I> , e,g , q' 1 1
Amount received:
Phone: ( - TO 3) A4.,) - '5`7O Fax: : ( 303) aba - 46(05 1
E - mail: 't' i I< & 600C o L4,01 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: C �a� - Submit two (2) sets of roof plan with connection details
o and fire department access, along with the 2010 Oregon
Address: a '7 P— NE. cc' - - L 4 to � kl> . Solar Installation Specialty Code checklist.
City /State /ZIP: . �D j c* '7 I 1 Permit fee (includes p lan review $180.00
and administrative fees):
Phone: (5613) otbat — 70 Fax: ( 50 3) aF - (0(05
State surcharge (12% of permit fee): $21.60
CCB lic.: I b 77 0 a- 4 Total fee due upon application: $201.60
Th is p
Authorized signature: ��'�"�� "" permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: }It 1 G�.1gEL- J . f-tA Tt _e s Date: ip J i g J 12 _
* Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I 1/02/COM/WEB)
Building Division
Over- The - Counter (OTC) Building Permit
TIGnKO` Check List
Project Description: i 1 ti Pe.1-0 (? • ed >0 �
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: f — Occupancy Group: Type of Construction:
*Type of Use: r Occupancy Load: Oregon Specialty Code: Z ..
SPECIFICS
Number of Stories: i 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: Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ 000 FEES DUE
$ , Quo DC Prov Rvw, COM TI — Ping
$ � (' (. c DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ `D F .0 Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ 6 ( , 9 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ 370, f Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 • $ ZQ?�(G� Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ �,re Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ , , 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: ' $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ I 85 ,(A-TOT AL FEES DUE
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK 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.
I: \Building \Forms \OTC - BUP.docx 07/01/2012
Building Division
Development Code Provision Review
T rc R ° Commercial Projects - No Associated Land Use Case
Building Permit No: Ili E xpedited Review
Plan Submittal Date: /'(77 -, if //7
To the Applicant:
➢ 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 o ly if approved.
� �
Planning Review (contact at 503 -718- 2 �" r @tigard- or.gov)
Proposal:
Zoning ( _� (a
Permitted Use Yes Lr1 No ❑ /
Land Use Required: Yes ❑ No LN'
Notes:
/Approved ❑ Not Approved Date: o? _dam
REVISED 10/4/12