Permit n CITY OF TIGARD N '� 3 y'~ BUILDING PERMIT
COMMUNITY DEVELOPMENT
Permit BUP2013-00173 •
T[G'ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 1 S136DA00800
Jurisdiction: Tigard
Site address: 11538 SW PACIFIC HWY
Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Replacing existing expresso drive up building with new building less than 10%larger and new ownership.
11/20/13,reprinted to correct address from 11540 to 11538 SW Pacific Hwy.
Contractor: PORTLAND ROAD&DRIVEWAY CO INC Owner: HIGH HAT RESTAURANTS, INC
10500 SE JENNIFER ST 11530 SW PACIFIC HWY
CLACKAMAS,OR 97015-9511 TIGARD, OR 97223
PHONE: 503-650-5006 PHONE:
FAX: 503-650-8022
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: NEW Type of Const: VB Permit Fee-COM-New Construction 08/06/2013 $701.82
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 08/06/2013 $84.22
Dwelling Units: 0 Plan Review 07/15/2013 $456.18
Building Misc Fund(copies/prints) 08/06/2013 $2.00
Stories: 1 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 08/06/2013 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $80,000 Tig-Tual School CET-Non Residential 08/06/2013 $120.45
COT Address Fee 11/19/2013 $50.00
Floor Areas:
Total Area: 219 •
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,416.67
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking: 0
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wit
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-00 • • !h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332 2344.
Issued =y: � Permittee Signati N e:
Call 503.639.4175 by 7:00 a.m.for the next available inspectiun-date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
CITY OF TIGARD BUILDING PERMIT
;' ! COMMUNITY DEVELOPMENT Permit#: BUP2013-00173
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 1 S 136DA00800
Jurisdiction: Tigard
Site address: 11540 SW PACIFIC HWY
Project: Black Rock Coffee Bar Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Replacing existing expresso drive up building with new building less than 10%larger and new ownership.
Contractor: PORTLAND ROAD& DRIVEWAY CO INC Owner: HIGH HAT RESTAURANTS, INC
10500 SE JENNIFER ST 11530 SW PACIFIC HWY
CLACKAMAS, OR 97015-9511 TIGARD,OR 97223
PHONE: 503-650-5006 PHONE:
FAX: 503-650-8022
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: NEW Type of Const: VB Permit Fee-COM-New Construction 08/06/2013 $701.82
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Building 08/06/2013 $84.22
Dwelling Units: 0 Plan Review 07/15/2013 $456.18
Building Misc Fund(copies/prints) 08/06/2013 $2.00
Stories: 1 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 08/06/2013 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $80,000 Tig-Tual School CET-Non Residential 08/06/2013 $120.45
Floor Areas:
Total Area: 219
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,366.67
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: No Protected Corridors:
Smoke Detectors: No Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTI••• e :•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-I• 'through OAR 95 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is.ued By: // // Permittee Signatur
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r,
' Building Permit Application P NOISIAIQ JN1a7I118
Commercial GUM UOA113 FOR OFFICE USE ONLY
Received
City of Tigard EIOZ S I lfi( Received
: /5 w- Permit No
IN
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review° /�
III ° Phone: 503-718-2439 Fax: 503-598-1960 A; i Date/By: C f l Other Permil!y/`iA�/3 Am
l`I G n R D Inspection Line: 503-639-4175 � � . All Date Ready/B / Juris: ® See Page 2 for
e Internet: www.tigard-or.gov Notified/Method: 0j,ji} 7� 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(romded 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 Valuation: $
❑Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: H S/0 S"/ I'i[A z I,� New dwelling area: square feet
City/State/ZIP: T j,r/ 'tj6i t Garage/carport area: square feet
Suite/bldg./apt:no:: Project name: aicc(<C goa CON 11e-1' 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.
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.
Valuation: $80400
Existing building area square feet
New building area: 7 I q square feet
❑ PROPERTY OWNER [TENANT Number of stories:
Name: S„kt Sp((r„,,7 , Type of construction: 14( -.GI)Address: /7-4 117 /1.1/ W--/ Occupancy groups:
City/State/ZIP: (it c ac t,,,,,,,0 J O 1 . q 70. s.-- Existing:
Phone:(505) 9 7-u -3 ;'9.4 Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON BUILDING PERMIT.FEES*
Business name: /p,(( ��/c 6,c 8",-- (Phrase refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: At 01✓t
FLS plan review fee(if applicable):
Address:
City/State/ZIP: - Total fees due upon application:
Phone:( ) Fax: :( ) Amount received:
E-mail: PHOTOVOLTAIC.SOLAR PANEL SYSTEM FEES* .
Commercial and residential prescriptive installation of
CONTRACTOR _ roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Par c,/ ko .4.Or rr. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 10�Q Se you itc-r Solar Installation Specialty Code checklist.
City/State/ZIP: C[a ck "tc-&S O(Q 70 l S' Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503 ) (05v - sJola Fax:( ) State surcharge(12%ofpermit fee): $21.60
CCB lie.: 7 I Total fee due upon application: $201.60
Authorized signature:r' This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 34-e Spe f6.. f7,� Date: VAT/3 * Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.12/11/2012 440-613T(11/02/COM/WEB)
1
rJ
7111 q 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] $
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: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2]of Valuation Computation): $
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.12/11/2012
I,
IIIIII
Building Division
Plan Submittal Requirements
T►G A R D 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.
I:\Building\Pemtits\BUP_COM_PermitApp.doc Rev.12/11/2012
III Bue
ilding Division
Plan Submittal Requirement Matrix
T I G A R D Commercial&Multi-Family-New,Additions or Alterations
Type of Submittal # of Plans
(Includes new,additions and alterations.) Required at
Submittal
Demolition Permit 3
(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\Permits\BUP_COM_PermitApp.doc Rev.12/11/2012
o Building Division
Development Code Provision Review
r I c A It°c-D Commercial Projects - With Approved Land Use
Building Permit No.: tP.2O/3 —i 0/ 73
Land Use Casc File No.: /7/t1 6.2.0/3 —O 0 0 as
Project Name: L3LA(!t. 72.d elm COf` &-
Site Address: //s%0 SA) /4"-C// / G / 0 y , Suite/Bldg #:
Plans Routed:
Original Plan Submittal Date: 2A_S 3 Routed By:
1St Revision Submittal Date: Routed By:
2nd Revision Submittal Date: Routed By:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies
to the Building Division. Only checked (1) items are approved. Items not approved and those listed in the
notes must be revised prior to re-submittal. For questions please contact the appropriate staff person(s) listed
above each section.
STAFF: please only mark those items on the left side that are approved.
Planning Review(contact DO u" F4i le at(503) 718-qQL / or @tigard-
or.gov
hM'Land Use Approval
❑ Building Plans Match Approved Plan: Yes No ❑
❑ Maximum Building Height
❑ on /WA/
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved Not Approved ❑ Date: 7--id--/�
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
1:\CURPLN\Masters\Development Code Provision RevieWDCPR_COM_WithLandUse.doc Rev.01/16/13
• •.u, i
Engineering Review(contact Mike White at(503)718-2464 or MikeW @tigard-or.gov)
Er Actual Slope: _r.__
❑ PFI Permit#
❑ Conditions Met
Notes:
Original Plan: Approved# Not Approved ❑ Date: 1" GI/3
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review(contact Albert Shields at(503)718-2426 or albert @tigard-or.gov)
❑ Planning Okay to Issue Permit ❑ Arborist Okay to Issue Permit
❑ Engineering Okay to Issue Permit
Notes:
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes No ❑
Date Routed to Building: /G _
Page 2 of 2
1:\CURPLN\Masters\Development Code Provision RevievADCPR COM_WithLandUse.doc Rev.01/16/13
a
CITY OF TIGARD FEE AND PAYMENT HISTORY
q
III 0 . 13125 SW Hall Blvd.,Tigard OR 97223
• 503.639.4171
TIGARD
I
BUP2013-00173 - 11540 SW PACIFIC HWY, TIGARD, OR 97223
i
Revenue i Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-COM-New Construction 230-0000-43104 $701.82 $701.82 $701.82
12%State Surcharge-Building 100-0000-24001 $84.22 $84.22 $84.22
Plan Review 230-0000-43106 $456.18 $456.18 $456.18 7/15/13 Credit Card 192227 $0.00
Building Misc Fund(copies/prints) 230-0000-45319 $2.00 $2.00 $2.00
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $2.00 $2.00 $2.00
11x17)
Tig-Tual School CET-Non Residential 230-0000-24102 $120.45 $120.45 $120.45
Totals for Fees $1,366.67 $1,366.67 $456.18 $910.49
Receipt# Payment Method Check# Pavor: Receipt Date Receipt Amount
192227 Credit Card Jake Spellmeyer 07/15/2013 $736.91
Total Payments: • $736.91
' Balance Due: $62 .76