Permit see;; 5Su
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Community Development �+° o � '
TIGARD
Request for Permit Action
TO: CITY OF TIGARD V ® I
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223 4,7102 X.
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: Ron Kief Day Road Design LLC
INVOICE TO: (Business or Individual)
Mailing Address: 9825 SW Day Rd
City /State /Zip: Sherwood, OR 97140
Phone No.: 503 - 320 -0918
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: BUP2012 -00114
Site Address or Parcel #: 7301 SW Dartmouth
Project Name: Scan Design Furniture
Subdivision Name: Lot #:
EXPLANATION: Project did not happen
Signature: ,i QL/ " ll{.I �.. " Kli,6 Date: 10/24/12
Ron Kief �` (( VU
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80'7o of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 °/o of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B Rte to Bld • Admin: Date /ot. ® B 7
Refund Processed: Date AI 9 B ,iii/ Invoice Processed: Date 4,1/,9 /ii By .:
Permit Canceled: Date /,2/8 /•Z By i v Parcel Tag Added: Date By
Receipt # Date Method Amount $
l:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
Building Permit Application
Commercial RECEWED FOR OFFICE USE ONLY
II - City of Tigard Date /B : Received 6 � ��� � Permit No a, / � Pt� /� --40//9 13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 6 2012 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1960 Date /B :�kfii �� Other Permit:
TIGARD Inspection Line:
Internet: tv .639 CI OF1'IGARD D ate Rea. y: / /� / .4� Juris See See Page 2 for
Internet: ww.tigard- or.gov BUILDING DIVISI® Noti ed /Method: Y D 27 /' 77G Supplemental Information
TYPE OF WORK REQUIRED DATA: I- A 2-F AMILY 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.
❑ I - and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7301 SW Dartmouth New dwelling area: square feet
City /State /ZIP: 'Tigard 97223 Garage /carport area: square feet
Suite /bldg. /apt. no.: Project name: Scan Design Furniture Covered porch area: square feet
Cross street/directions to job site: 72 " Ave 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.
Demising waI fighting .y' y E`EL is /q, /9-/JP Valuation: SS42,000.00
Existing building area: 16380 square feet
New building area: 16380 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: I
Name: American Industries Type of construction: V - B
Address: 1750 NW Naito Parkway, Ste 106 Occupancy groups:
City /State /ZIP: Portland 97209 Existing: M
Phone: (503)478 -6603 Fax: ( )
New: M
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedull
Business name: Day Road Design, LLC
Structural plan review fee (or deposit):
Contact name: Ron Kief
FLS plan review fee (if applicable):
Address: 9825 SW Day Road
City/State/ZIP: Sherwood 97140 Total fees due upon application:
Phone: (503) 320 -0918 I Fax: : (503) 570 -8713 Amount received: 73 36,
E RonKicf @comcast.nct PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mountee hotoVoltaic Solar Panel System.
Business name: CPS Construction, Inc Submit two (2) sets e f roof plan with connection details
and fire department a ess, along with the 2010 Oregon
Address: 9825 SW Day Road Solar Installation Speci , Code checklist.
City /State /ZIP: Sherwood 97140 Permit fee (include elan review , . v
and administra . 'e fees):
Phone: (503) 320 - 0918 Fax: (503) 570 - 8713 State surcharge (12% of permit ; •, . $21.60
CCB lie.: 102248
Total fee due upon e ication: $201.60
mp ree,4fRip Authorize This permit applica '. n expires if a permit is r t obtained
I/ i�i�� within 180 da '• after it has been accepted as co plete.
Print name: Ron Kie ..--- I Date: 06/06/12 * Fee met lo•. ogy set by Tri- County Building Industry
Service Board.
I: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM /WEB)
. 11 .„, 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] $ (p
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 =7 ■�_a $ (e
(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): $
l: \Building\ Permits\ BUP -COM PermitApp.doc 03/03/2011
■
Building Division
Plan Submittal Requirements
TIGARD 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 ❑ 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.
1: \Building \ Permits \BUP -CO\1 PcrmitApp.doc 03/03/2011
Building Division
Plan Submittal Requirement Matrix
TIGARD 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 \Pomits \BUP -CO\1 PemlitApp.doc 03 /03/2011
Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: i it /°. /o? — 4 7 /// ❑ Expedited Review
Plan Submittal Date: 6///s2 ■
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 only if approved.
Planning Review (contact at 503 718 or 40_@ti
ICJ Zoning e_--c._- Permitted Use Yes No ❑
E Land Use Required: ❑ No (ex lain below)
n below)
Notes: Y , J h4'
.._ / � �> 1 �/ A/”
Approved ❑ Not Approved Date: b//
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date: Y
I: \CURPLN
•� CITY OF TIGARD
° , Building Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503.718.2439
INVOICE
TO: Day Road Design, LLC Customer ID: 102248
Attn: Ron Kief Invoice No.: INV2012 -00015
9825 SW Day Rd. Invoice Date: 12/3/2012
Sherwood, OR 97140 Date Due: Upon Receipt
Case No. Site Address Subdivision - Lot # or Project Name Amount Due
BUP2012 -00114 7301 SW Dartmouth St. Scan Design Furniture $73.00
Invoice Total: $73.00
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2012 -00114 Customer ID: 102248
Site Address: 7301 SW Dartmouth St. Invoice No.: INV2012 -00015
Project: Scan Design Furniture Invoice Date: 12/3/2012
Date Due: Upon Receipt
Invoice Total: $73.00
Amount Paid: $
Office Note: Route copy of receipt to Dianna Howse
Please mail payment to:
City of Tigard, Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
1: \Building \ Accounting \l nvoice.doc 01/14/2011
:'""% CITY OF TIGARD FEE AND PAYMENT HISTORY
13125 SW Hall Blvd., Tigard OR 97223
w „,,, 503.639.4171
.TIIGARU
Y .�a!E
BUP2012 -00114 - 7301 SW DARTMOUTH ST, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Plan Review 230 -0000 -43106 $416.84 $416.84 $416.84 6/6/12 Credit Card 187048 $0.00
Plan Review - Fire Life Safety 230 - 0000 -43108 $256.52 $256.52 $256.52 6/6/12 Credit Card 187048 $0.00
DC Provision Review, COM TI - Ping 100 -0000 -43112 $64.00 $64.00 $64.
DC Provision Review, COM TI - LRP 100 -0000 -43117 $9.00 $9.00 $9.00
Totals for Fees $746.36 $746.36 $673.36 $73.00
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
187048 Credit Card Ronald L Kief, Day 06/06/2012 $673.36
Road Design LLC
Total Payments: $673.36
Balance Due: $73.00