Permit V 0 //s./';
Community Development R- CENED
TIGARD
Request for Permit Action MAY t 5 2012
CITY OF TIGARD
TO: CITY OF TIGARD BUILDING DIVISION
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 Applicant El 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 (
M CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: !7 of 2-6 / 2 - exQ 4#-
Site Address or Parcel #: M6S70 SW 97 $ ' ,411/• 77c/94L2 ( /7z24
Project Name: 7 J,9u re 49 40e6" SCtfoo L - SCeyvice /26406E-
Subdivision Name: Lot #:
EXPLANATION: 5CO3 Of /2J14<g g_6-99e :6-‘0 j L-07/752,
i (/ 7 A/EP
Signature: / # Date: -- / 5/i
Print Name: f' (( — WA/ ' Y
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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.
e) not more than 80% of the building permit fee for issued permits poor 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 -4 weeks for processing refunds
FOR OFFICE USE ONLY
Rte to S s Admin: Date viriffsicisliji Rte to Bid. Admin: Date /1VPM : „r
Refund Processed: Date By Invoice Processed: Date /i¢ By
Permit Canceled: Date // /, 2._ By ;7: arcel Tag Added: Date By
Receipt # Date Method Amount $
1. \ Building \ Forms \Regl'errnitAction.doc Rev 04/26/2011
Building Permit Application
V t3 1 2//e/a. ve
Commercial F OFFICE USE ONLY
City of Tigard ECE W ED Re cei
II q 13125 SW Hall Blvd., Tigard, OR 97 Date /B ved ® , � � � Permit No : Po70!� --�� b.
Pho ne: 503.718.2439 Fax: 503.598.196 2 Plan Revie .
° OM 0 2-0 Date /B . i` M Other Permit.
T I G A R D Inspection Line. 503.639 Date Ready : y. Juris ® See Page 2 for
Internet: www.tigard- or.gov GM OFTIGRRp I Notified/Method. ,3 e m Supplemental Information
TYPE OF vsautic DI\,tS OW 4D 5 IC,- tai : 7 1 ' 1 -. c) ,'?/
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 ❑ Multi- family Number of bedrooms:
❑ Master builder ® Other: School Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 14650 SW 97 Ave. New dwelling area: square feet
City/State /ZIP: Tigard/OR/97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Twality 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: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Science classroom upgrades Valuation: $3,000.00
Existing building area: square feet
New building area: square feet
Z PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Tigard Tualatin School District Type of construction: VN
Address: 6960 Sandburg St. Occupancy groups:
City /State/ZIP: Tigard/OR/97223 Existing: E
Phone: (503)431 - 4000 Fax: ( ) New:
❑ APPLICANT ® 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
Amount received: /A 5-, ai
Phone: (503) 226 -6950 Fax::( )
E -mail: billc @dowa.com .
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Corn - cial and residential prescriptive install. '.n of
roof - top . nted PhotoVoltaic Solar Pane " ystem.
Business name: TBD Submit two ( " -ts of roof plan with c• nection details
and fire departmen : cess, along . the 2010 Oregon
Address: Solar Installation Spec:, I Co checklist.
City/State/ZIP: Permit fee (includes . review $180.00
and ad ' strative - es):
Phone: ( ) Fax: ( )
State surchar ! : 2% of permit fee). $21.60
CCB lie.:
Total fee due upon application: $201.60
Authorized signature: 4 / 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.
I: \Building\Pcrmits \BUP -COM PermitApp.doc 02/24/2011 440- 613T(I 1 /02 /COM /WEB)
V n - 9 /r a, wa.0� -� frisk._ c=h .
...._., u ,IIN
• a Building Division
Development Code Provision Review
T I G A R D Commercial Projects - No Associated Land Use Case
Building Permit No: -•- P0.0 gO l2- — 00614 ❑ Expedited Review
Plan Submittal Date: Z /alia.
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 -z`i�y or ay. p @tigard - or.gov)
,0 Zoning ( - �. s- Permitted Use Yes •0" No ❑
11- Land Use Required: Yes ❑ No Er (explain below) 1
Notes:
a ❑ Not Approved Date: 3 --1 '' 1 2 --
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
Notes:
Routed ba uilding Division Date:
I: \CURPI.N