Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
V D.e:
•
Request Permit Action
T I G.AR D. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
Pl
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 ❑ Applicant ❑ Contractor City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) x
Mailing Address: ��/
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (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 #: CRQ / � j Q(� / l S
Site Address or Parcel #: 7 3fi /J4 T F Pd /L7" i 7J
Project Name: l-UC OLD J£. Q/ L
Subdivision Name: Lot #:
EXPLANATION: c pt._ of W o )io i E-£4/21..0 2�
_ c P AF B- o&i) .
Signature: ' ).C 1 -1C ) C9-44Adtlfid Date: 5! ' 5//
Print Name: l T) th 'E /4 - H3 - kl
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date fareillreMPV, Rte to Bld: Admin: Date 5AgerM B !r
Refund Processed: Date /VAillnibe Invoice Processed: Date B
Permit Canceled: Date / . B M. Parcel Ta• - Added: Date B
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
., Building Permit Applicatio rA)
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Commercial
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City of Tlgar 1 3 l DatReceiveeBy: d 15 /3 Permit No.: 6 „ Pa i ;-coa 5 -
1 ° 13125 SW Hall Blvd., Tigaf k 97223 4 Plan Review O
1 Phone: 503 -718 -2439 Fax: 503 -59$ p v ,% Other Permit:
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CC `, ,` D ateBy:
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'' I G A It D Inspection Line: 5-6394 "j o \ �`` P( , Date Ready/By: lurk' See Page 2 for
Internet: www.tigard -or.go V O � \U' p V \ 3 � + Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1 - AND 2- FAMILY DWELLING
( `• VI New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of 4 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 Valuation: S '
❑Accessory building El Multi- family Number of bedrooms:
Master builder ❑ Other: Number of bathrooms:
V � JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ''1'3'9 5W New dwelling area: square feet
City /State /ZIP: i i a r A ! t) V _ 11 7....4-A Garage /carport area: square feet
tte/bldg. /apt. no.: ,1 Project name: UAL er olive I v e 0 I Covered porch area square feet
Cross street/directions to job site: � � t I 11 ,E l / - D area: square feet
E-3110 - 11 u 4- -p �t.�l, r\(� r / ) Z 6 \ l� t � le-[ _ Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
N./VA Gl l 4.( 1. 0 r n \A (3)? 5. 5. T S Valuation: $
QII 1 71
e rte C C, R cyL.. r . l�
' S � &Q /9 ! i 1 K.32_ S9� � � , ' Existing building area square feet
• n New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories:
0
Name: ellI C Q\f\ o , Type of construction:
Address: "'1 7 ' tu 1 d ] ,� A- r A . Occupancy groups:
City /State /ZIP: , \ G r / 0 ' 7 ZZ'- Existing: ,....
Phone: (Cjp� �(� 22� v Fax: ( ) _ New:
APPLICANT ,CONTACT PERSON BUILDING PERMIT FEES*
Business name: P b Q h V L( C (Please refer to schedule)
1 Structural plan review fee (or deposit):
Contact name: Fit • 1\.A_.I ►-\1,.. FLS plan review fee (if applicable):
Address: 1 ?� lei <� jr 1 c 04,p �t.f 4.- (.c .
Total fees due upon application:
City /State /ZIP: j 11 4” Y r , 0 P G\ Z z
Phone: (6 b?�) - Z 0 el - 2, a Fax:: ( ) Amount received: ��( J�
sl E -mail: e C 6 I L (Q , C72 II V�h 1 (- G6 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CC�� Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Submit two (2) sets of roof plan with connection d ails
() Business name: V._4 h \) il M 5 S t
and fire department access, along with the 010 egon
�- Address: Ol 2 O ` Se , q l 5 Y a v Solar Installation Specialty Code checklist.
Permit fee (includes plan review
o z.. City /State /ZIP: .? 0 or \ e. • r 2 -L Z ff, and administrative fees):
~ J Phone: (60 (o a 2 Fax: ( State surcharge (12% of permit fee): 21.60
CCB lic.: (V `T q 2O Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Eki I * Fee methodology set by Tri- County Building Industry
C I L �� Date: h f I Service Board.
I:\ Building \Permits\BUP_COM_PermitApp.doc Rev. 12/11 /2012 440 -4613T(11 /02 /COM/WEB)
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Building Division
Accessibility: Barrier Removal Improvement Plan
Ti , G A
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] $
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 $
(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: $
(0 Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
1: \ Building \ Permits \BUP_COM_PermitApp.doc Rev. 12/11/2012
RECEIVED
MAY 1 32013
CITY OF TIGARD
BUILDING DIVISION
12'_2 1/4"
A _ 1 V2^ t I
a I I I I � @' 1 I () I/ 11 I I 11 l 2S INs THREADED PIN
�� �� � + 7 L L L ��� �C , 1 I LI I I 1D" INSERT
EPDXY INFILL
518" SPACER
10"
SOLID CAST
ALUMINUM
LETTERS
BRUSHED
FINISH
10'- B"
STUCCO WALL SURFACE
r �
® SECTION
SCALE: 3 " =1' -0"
(/I b 4 I..
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ENTRY ELEVATION
SCALE: 1/2" =1'-0"
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