Permit City of Tigard, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223 - . •
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October 2, 2009 •
Bateman Construction Inc.
4991 SW Nevada Ct.
Portland, OR 97219
Attn: Steen Bateman
Re: Permit No. MST2009 -00186
Dear Mr. Bateman:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11675 SW Tiedeman
Project Name: Gutierrez
Job No.:
Refund: ® Check #101088 in the amount of $54.70.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Current planning denied construction in flood zone. Refund 100% of application
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4 -
Dianna Howse
Building Division Services Supervisor
Enc.
1: \Building\ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 0 Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772
t wilding Permit Application x ,,/4 /A/ PR e- , q /Zy %F
i✓ CalTrillFFekti Q' IAe7T Iyip , FOR OFFICE, USE ONLY
City of Tigard teB ��/ f PermitNo/yS7 oa9 _ /d o
II ° 13125 SW Hall Blvd., Tigard, OR 97 � 3 n Plan Revie _ ' Phone: 503 :639.4171 Fax: 503.59 0 2 a Date Other Permit:
T 1 GA KD Inspection Line: 503.639.4175 P v • Date B Read B Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGAR I . .
l ING
Btn n DIVISION- '- Notified/Method: 7� Supplemental Information
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H ` TYPE' OF WORK ' - REQUIRED 'DATA 1 FAM DW
ILY ELUNG
❑ 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 the • , -' - , ' ' ' - - ' CA'I'EGORY CONSJCT
IRIION '; : . "� , � . : . - =" „ ` =.. �' `d. w ork indicated on this application. e,
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l- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 3���s
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❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
" -JOB SITE '.INFORMATION ANDI: LOCATION. - Total number of floors:
Job site address: // C 7, j �a ) R4 � New dwelling area: square feet
City /State /ZIP: p%oA? 7 v!�- p ) Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 629 Covered porch area: square feet '
Cross street/directions to job site: 2 (a 77 8 --- .//CZ Deck area: square feet
Other structure area: 6%.r66 square feet 7 7
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 .OFWORKb >','�; r. work indicated on this application. -
,ewG49 -77 SBi � T , S � „ ` e-,449,9 Valuation:
K�'C�fS Existing building area: square feet
New building area: square feet
PROPERTY: OWNER ' , ' ..'< : ,❑,TENANT Number of stories:
Name: (7062..„, )06- CT L(7"7 & - Type of construction:
Address: !/ A 75 � 14. 77,47-vg Occupancy groups:
City /State /ZIP: 77 t 0 t' . Existing:
Phone: (97, 222, 7 / 3 l Fax: ( ) New:
yi APPLICANT, - I® :CONTACT,•= PERSON
� � �:. w.:.... � �
Business name: ~
oiwz„ ®871.jA- All Contractors and subcontractors are required to be
Contact name: V v6Z pew. 4 licensed with the Oregon Construction Contractors Board
` /I N , under ORS 701 and may be required to be licensed in the
,, 675
Address: a ! T� jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP:
apply:
Phone: ( 97/) ZZZ 773/ Fax:: ( )
E -mail:
CONTRACTOR . ) .' . .,.
Business name: LO„� T/e!/C 2L ���i . .BUILDTNG-PERMIT FEES *•... '
Address: c../. /) - /z � )x0 �,(- c � ''' v i e w e. r e ( o r dei) ule),` . �. '
City /State /ZIP: �D2' ��� � Structural plan re fee (or deposit): .5-2/, 70
�� r �// FLS plan review fee (if applicable):
Phone: (SOS) 4l -7 3 Fax: ( v 720 ,---' ell egh
p B lie.: �/J 0/ � `Q Total fees due upon application:
Amount received: sy, 7
Authorized signature:
This permit application expires if a permit is not obtain r
within 180 days after it has been accepted as complete.
Print name: .5-7� �+ ,- v / Date: i ✓ .._, 67 * Fee methodology set by Tri -County Building Industry
Service Board.
l: \Building\Permits \BUP -COM PermitApp.doc 2/23/07 440- 461 I /02/COM/WEB)
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,' RESIDENTIAL ' WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
fzCOMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls ++
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n Clock Systcms
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
Instrumentation
• n Intercom and Paging Systems . •
n Landscape Irrigation Control* •
❑ Medical •
❑ Nurse Calls
❑ Outdoor Landscape. Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
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= Accessibility: Barrier Removal mprovement Plan
T1GA_RD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
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(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 pei -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: - [1] $
MULTIPLIER (25% barrier removal requirement): x .25
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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 $ 'i.
I,
(b) An accessible entrance: 15' '
(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: ' $ ,
1 l r.
(f) Accessible drinking fountains: and, • , $ .
{;
. (g) When possible, additional accessible elements. such as storage and
alarms: $ ' .
TOTAL (shall equal line [2] of Valuation Computation): • $
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I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08 . L
Electrical Permit Applicat C EIVED FOR OFFICE USE ONLY
� �� �� VV
City of Tigard Permit No.
: 131 R eceived SW Hall Tigard, Ti ard, OR 972Q P 1 7 2009 PlateB : / Q � '� � — O/ f�U� t�
Y 88 Plan Review
Phone: 503.639.4171 Fax: 503.598. Date/B ! Other Permit:
TIGARD
Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: S lil upplemental Page 2 for
Internet: www.tigard- or.gov Notified/Meth/Method: Supplemental Information
TYPE 0 ,` s • 4 ' , I PLAN REVIEW
❑ New construction ddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
Job no.: I Job site address: pC7 �� n���t / � Six or or more. occupancy.
❑
�7 ❑ Six or more e residential units. Recreational vehicle parks.
City/State /ZIP: 7-76.,47 /I �// ❑ Health -care facilities. ❑ Supply voltage for more than
! / (( ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: / ,tJ.4- �, V ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 7 / Description I Qty. I Fee. I Total I "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
�� Limited energy, multi - family 75.00 2
77 s ( � / / / rn � residential (with above sq. ft.)
/ /7 J Services or feeders installation, alteration, and/or relocation
/
200 amps or less 80.30 2
ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: �f Gi() T7 < , fEee -7 401 amps to 600 amps 160.60 2
� �� 601 amps to 1,000 amps 240.60 2
Address: //‘75' , 5 -2..1 77822 Over 1,000 amps or volts 454.65 2
City/State /ZIP: 7 p tne Temporary services or feeders installation, alteration, and/or
relocation
Phone: (97/) 0 2 , 7 7� 3 l I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: ( 7)ITI , � T / E � .et -7 13. Fee for branch circuits
Contact name: N �� /
without service or feeder fee, 46.85 2
first branch circuit
Address: �/6 7.S G% / -79. Each add'I branch circuit 6.65 2
S �V Miscellaneous (service or feeder not included)
City/State /ZIP: 776.-- nZ Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (9 7/) ZZ Z 7/ 5/ Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 2?Z.93 0006-- CLe-C// ( energy panel, alteration, or
Address: 52,50 Si � t ,\.) e) extension. Describe: Page 2 2
City/State /ZIP: 6, oz__ 9-7 Z Z / Each additional inspection over allowable in any of the above
S Fax Per inspection 62,50
Phone:
( U_3 ciC -- CI 7 (56 2 y 4 , / / 3 Investigation per hour (1 hr min) 62.50
CCB Lic.: J3 50 / Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
4 \Building'Permits\ELC- PermitApp.doc 05/23/06 440 -4615T(ti /05 /COM/WEB
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CITY OF T'IGARD - SITE PLAN REVIEW
' ..9 v 71 BUILDING PERMIT NO,: /yS1o?oo 9 —/5D/6e6
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P LANNING DIVISION:
E a Approved/ ❑ Not App r .
r 15." O � a Required Set ❑ A pp:o I �
Z ",
.. / Side: Street Side:
Z ''
l ��'f. � From. �. �;; r<c_P� Rear:
nQ. OD , Visual Clearance: 0 Ap roved ❑ Not .'`:"'
.1 a Maximum Building Height• feat
v CWS Service Provide If [: << •e_. ❑ Ye 0
g v tv R c�:►�'�.�i
F+ vl > Y. 0 ,�/
1. 1? BN : , 1l,l JJi Date: ' K' 07 ._._._.r
q ¢ $ ENGINEERIN DEPARTMENT: .
1 O ❑❑ Actual Slope: _% ❑ Approved ❑ Not Approved
0 ,1— Site Plan: ❑ Approved ❑ Not Approved
E.- " B Date:
C O c Notes: di_ 1.1714./3 ctve,,.J'
°- . i .� /t-t-aA-- ■ ■ l....-r✓
, z ii 1-- 6,0„ 1)--uhict- ATALLelau....„,leato -.) ih y v � m Z 0 OO - m
p -I --7 s
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// 6 i 500 ✓ 1.
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oa City of Tigard
TIGARD; Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request . for Perm.1Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Bateman Construction Inc. DATE: 9/24/09
4991 SW Nevada Ct.
Portland, OR. 97219 REQUESTED BY: Dianna Howse
Attn: Steen Bateman
TRANSACTION INFORMATION:
Receipt #: 175252 Case #: MST2009 -00186
Date: 9/17/09 Address /Parcel: 11675 SW Tiedeman
Pay Method: Check Project Name: Gutierrez
EXPLANATION: Current Planning division denied site plan for construction in flood plain. Refund
100% of plan review fees.
REFIJ I'NF.;OR3�1i4.Ti`QN:.. •
Fee; De "s.cri tion: From: >Recei •t..'' "': - ' . 'i i;_
f - `Revenue:ticcouat,:No. � ;:;.
;'E cam 1e; ;:: UILD' Per n t.Fee
,.._.P.....,..� . ... � ..........:. ... OOOQ4320 '.$:Aiqunc:
Plan Review 2300000 -43106 $54.70
TOTAL REFUND: $54.70
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager ✓ , �+ J�
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR. ACCELA,SYSTEM`AIDMI:NISTRATIOIV
Refund Request Reviewed: Date: By: :;`1T "f;`
Case Refund Processed: Date: jz /, e-7 By _
[: \Building \Refunds \RefundRequest.doc 04/13/09
CITY OF TIGARD RECEIPT
C 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
C?
/ /L A / •
Receipt Number: 175427 - 10/02/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER . PAID
MST2009 - 00186 $ - 54.70
Total: $ -54.70
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check. 101088 DHOWSE 10/02/2009 $ -54.70
Payor: Bateman Construction Inc.
Total Payments: $ - 54.70
Balance Due: $54.70
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Page 1 of 1
• CITY OF TIGARD RECEIPT
Q
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 175252 - 09/17/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2009 -00186 Plan Review 2300000 -43106 $54.70
Total: $54.70
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check . 4284 DADAMSKI 09/17/2009 $54.70
• Payor: Bateman Construction Inc.
Total Payments: $54.70
Balance Due: $0.00
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Page 1 of 1
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I II e Community Development
TIGARD Request for Permit Action , p, ,; �, �. `k ' �l ^
•' .','''''1:-'
-. - t o w:
TO: CITY OF TIGARD vTiliAV
Building Division Services Coordinator i� D�;�I
�-
13125 SW Hall Blvd., Tigard, OR 97223 13131 ' ��
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor i 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 receipt, if available). •
El INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: H 6T 2009 - 001g Co
Site Address or Parcel #: We 75 6 % / Eb £r/A
Project Name: a Lk / “2,12...f._ '—
Subdivision Name: Lot #:
EXPLANATION: ih L(Z Pt -pj f J Co 4 pj r-nUn} t6 i_!J 1%C,o01
l Lii 4Nr1) C /fADiJoT- 4E &u l t,i
Signature: � . Date: c( /94 /�q
Print Name: — T7 Eq R £ Q. 4bet-1,-teDK 1
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 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 Sys Admin: Date 9 i o9 B wU ; Rte toMEq Admin: Date ze c J By I? ilr
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt # Date Method Amount $
I: \Building \Forms \RegPermitAction.doc Rev 07/26/07