Permit •
0 1 it: ECM /ED
1 1 11 o Community Development i: AY 2012
T 1 c n Request for Permit Action CITY OF TIGARD
(BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner Ix Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
® CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt).
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❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 15UP Z (Z' O Cn4r
Site Address or Parcel #: 40: 5u) GC,IT ,/Vc,7 77G.QD op< 97ZZ3
Project Name: f h4)LEez 17/0/X .C/` G J 5 34)ee Q ✓ Q-
Subdivision Name: Lot #:
EXPLANATION: f CO/ i E of 4042.1 fWeic -w J
././0w 7Z /hEP
Signature: / L � �` Date: s'"/ S` /L-
Print Name: //
Refund Policy
I. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously 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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 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 2 - weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date AriMfgall B •11 Rte to Bld • Admin: Date 7�® B _a!
Refund Processed: Date NAM B _ Invoice Processed: Date l ® B
Permit Canceled: Date ��
7// $// By t � arcel Tag Added: Date By
Receipt # • Date Method Amount $
I: \Building \Forms \RegPermitAction.doc Rev 04/26/2011
Building Permit Application `,, i1' i /CZ •
Commercial RECE\/ED FOR OFFICE USE ONLY
CI of Ti and Received .2 a A / P ermit N o.: i �1 �`
`J g 2 j 2� �2 Date /By: eL / u , ,il�. ^r.T�'
LI Plan Review I , 120 ' ° 13125 SW Hall Blvd., Tigard, OR 972 Phone: 503.718.2439 Fax: 503.598.1960 Date /By: v ' • der Permit:
T 1 G A R D Inspection Line: 503.639.4175 CITY O TIGA �D Date Rea y: / kris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIUISIOE� Notified/Method: A Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- 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 El Multi-family Number of bedrooms:
❑ M aster builder
0 Other: S chool Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10865 SW Walnut New dwelling area: square feet .
City/State /ZIP: Tigard/OR/97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Fowler Middle School 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: . 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.
Science classroom upgrades Valuation: $$11,000.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories: I
Name: Tigard Tualatin School District Type of construction: VN
Address: 6960 Sandburg St. Occupancy groups:
City /State /ZIP: Tigard/Oft/97223 Existing: E
Phone: (503)431 -4000 Fax: ( ) New:
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: Dull Olson Weekes Architects
Structural plan review fee (or deposit):
Contact name: Bill Conboy
FLS plan review fee (if applicable):
Address: 907 SW Stark St.
Total fees due upon application:
City/State/ZIP: Portland/OR/97205 ,(/
Phone: (503) 226 -6950 Fax: : ( )
Amount received: ya O w
E -mail: billc @dowa.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installatio . of
roof -top unted PhotoVoltaic Solar Panel • tem.
Business name: TBD Submit two sets of roof plan with c• 1 ection details
and fire departme ccess, along . • the 2010 Oregon
Address: Solar Installation Spe • N • •e checklist.
City/State /ZIP: Permit fee (inclu.: ..n review 5180.00
and . • inistrativ - es):
Phone: ( ) Fax: ( )
State sure I - .:e (12% of permit fee): 521.60
CCB lic.:
Total fee due upon application: .201.60
Authorized signature: X/ ` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Bill Conboy Date: Mar 2, 2012 * Fee methodology set by Tri-County Building Industry
Service Board.
1: \Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T( I l /02 /COM /WEB) •
'V 0 0 D 4„co4e4 1/411/tc&, 5 0- 1 10W \ I
I N
10 ,11
o ° Building Division
Development Code Provision Review
T I G n R D Commercial Projects - No Associated Land Use Case
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Building Permit No: ft UI.P e9te3 i a — nerS J ❑ Expedited Review
Plan Submittal Date: zl a j I ,-
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- V3/ / or 4r' @ tigard- or.gov)
p- Zoning E.' '1.5 Permitted Use Yes EL No
Er Land Use Required: Yes ❑ No Er (explain below)
Notes:
.Approved ❑ Not Approved Date: 3-.2_'• 1 2 —
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Div • : • ate:
1: \CIJRI'LN
i
I II a CITY OF TIGARD
° Building Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503.718.2439
INVOICE
TO: Dull Olson Weekes Architects Customer ID: C12 -0002
Attn: Bill Conboy Invoice No.: INV2012 -00004
907 SW Stark St. Invoice Date: 07/18/2012
Portland, OR 97205 Date Due: Upon Receipt
Case No:. • • Site Address ' Subdivision - Lot # or Project Name ' Amount Due
BUP2012 -00045 10865 SW Walnut St Fowler Middle School
Fees due for plan review completed $73.00
prior to request received from
applicant to cancel permit.
•
Invoice Total: $73.00
® Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: BUP2012 -00045 Customer ID: C12 -0002
Site Address: 10865 SW Walnut St. Invoice No.: INV2012 -00004
Project: Fowler Middle School Invoice Date: 07/17/2012
Date Due: Upon Receipt
Invoice Total: $73.00
Amount Paid: $
Office Note:
Please mail payment to:
City of Tigard, Building Division
Attn: Dianna Howse
13125 SW Hall Blvd.
Tigard, OR 97223
1: \Building \Accounting \lnvoice.doc 01/14/2011
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CITY OF TIGARD FEE AND PAYMENT HISTORY
i 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIIGARD
BUP2012 -00045 - 10865 SW WALNUT ST, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Plan Review 230 -0000 -43106 $156.66 $156.66 $156.66 3/2/12 Credit Card 185769 $0.00
Plan Review - Fire Life Safety 230 -0000 -43108 $96.40 $96.40 $96.40 3/2/12 Credit Card 185769 $0.00
DC Provision Review, COM TI - Ping 100 -0000 -43112 $64.00 $64.00 $64.00
DC Provision Review, COM TI - LRP 100 -0000-43117 $9.00 $9.00 $9.00
Totals for Fees $326.06 $326.06 $253.06 $73.00
Receipt # Payment Method Check # Payor: Receipt Date R Amount
185769 Credit Card Philip A Wentz - Tigard 03/02/2012 $253.06
Tualatin School District
Total Payments: $253.06
Balance Due: $73.00
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