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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Iiii I q Request Permit Action i-1(I A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tl rJ TO: CITY OF TIGARD ,r� Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov F # FROM: g Owner ❑ Applicant ❑ Contractor ❑ City SV (check one) j REFUND OR Name: lif j/7 INVOICE TO: (Business or Individual) 6;4°,4/ ;ce Li C Mailing Address: //cjo SW W/ C 714 Ae City/State/Zip: 7 ,/plA �/V 9 71/23 Phone No.: 5-4, 9'70 2 2"7 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ® CANCEL/VOID PERMIT APPLICATION. vg 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#: 13 u p a(2/4-/-, £7O2 03 Site Address or Parcel#: 1 I �j .c it/ C Ilei 4inProject Name: Grc,.✓ oc-r;ee Subdivision Name: Lot#: EXPLANATION: 4 A q/ieU Rip; r4' /O7 /9- ,L.. t'''... y ./7Al, � . . 0'C-re/IV/V /' ,262//CZ1....1, ) / / - 11/1" Signature: ..v A _`,..,,,,/ Date: /6 Print Name: vt9 e GCeettJ Refund Policy 1. The Director or ilding Official may authorize the refund of: a) any fee w ' h was erroneously paid or collected. b) not more than 80%a of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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°0 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"0 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. 'OR OFFICE USE ONLY Rte to Sys Admin: Date,3. 4 17 Q'_Y Rte to Bldg Admin: Date 3 ti Refund Processed: Datere /7 By i 7 Invoice Processed: Date By Permit Canceled: Date (/`/7 By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012 14• 1 . q TIGARD City of Tigard March 15,2017 Green Office,LLC Attn: Joe Green 11560 SW 67th Ave. Tigard, OR 97223 Re: Permit No. BUP2014-00203 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11565 SW 67th Ave. Project Name: Green Office Job No.: N/A Refund Method: ® Check#224101 in the amount of$1,980.91. ❑ Credit card"return"receipt in the amount of$ . Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ . Comment(s): Per applicant's request as project was abandoned. Refund 100%of permit and SDC fees. • If you have any questions please contact me at 503.718.2430. Sincerely, ,‘ 7);/0-/ 1--'2--- Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov n Ili a City of Tigard TIGARD Accela Refund Request 0 This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the ReguestforPermit Ac••tion form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Green Office,LLC DATE: 3/10/2017 Attn: Joe Green 11560 SW 67th Ave. REQUESTED BY: Tigard, OR 97223 Dianna Howse TRANSACTION INFORMATION: Receipt#: 197630 Case#: Date: 9/16/2014 BUP2014-00203 Address/Parcel: 11565 SW 67th Ave. Pay Method: Check Project Name: Green Office EXPLANATION: Per applicant's request as project was abandoned. Refund 100%of permit and SDC fees and retain all plan review fees per building official. D` r ® JON• . rt _ it R . C,ts,k � � u. ''' 1r4V, V bZPP,Z a g <a4 . t °t l':',' pi m T _fPa ®' t a3z t : _ i � . , . .Buildin: Permit 12%State Surcha•e 230-0000-43104 $1,407.95 100-0000-24001 168.95 Metro Const Excise Tax 230-0000-24010 Ti.-Tual School CET-Non Residential 180.00 230-0000-24102 224.011 Milmillijall .11 .11 IMMMMMMMMMMMMMIMIIIIIIIIIIIENEI INEMEMMEMEMEIMIMIIIIIMIliml TOTAL REFUND: $1,980.91 APPROVALS: SIGN U S/ ATE: If under$5,000 Professional Staff \ If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM,AD ANIS TRATION USE'ONLY Case Refund Processed: I Date: I .3/Za 7 1 By I - I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD BUILDING PERMIT II ■ COMMUNITY DEVELOPMENT Permit#: BUP2014-00203 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2014 Parcel: 1 S136DD00801 Jurisdiction: Tigard Site address: 11565 SW 67TH AVE Project: Green Office Subdivision: WEST PORTLAND HEIGHTS Lot: 6 Project Description: Exterior&interior remodel with approximately 400 sq It addition Contractor: JOE GREEN INVESTMENT CO Owner: GREEN OFFICE LLC 11560 SW 67TH AVE, SUITE 333 ATTN:JOESPH E GREEN TIGARD, OR 97223 11560 SW 67TH AVE TIGARD,OR 97223 PHONE: 503-806-3004 PHONE: 503-806-3004 FAX: 503-639-8210 Specifics: FEES Description Date Amount Type of Use: COM Class of Work: ADD Type of Const: Vg Permit Fee-Additions,Alterations, 09/16/2014 $1,407.95 Demolition Occupancy Grp: B Occupancy Load: 70 12%State Surcharge-Building 09/16/2014 $168.95 Dwelling Units: 0 Plan Review 08/28/2014 $915.17 Stories: 2 Height: 0 ft Plan Review-Fire Life Safety 08/28/2014 $563.18 Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 09/16/2014 $278.00 Value: $150,000 DC Provision Review,COM TI-LRP 09/16/2014 $41.00 Info Process/Archiving-Lg$2.00(over 09/16/2014 $88.00 11x17) Floor Areas: Info Process/Archiving-Sm$0.50(up to 09/16/2014 $37.50 11x17) Total Area: 393 Metro Const.Excise Tax-Commercial 09/16/2014 $180.00 Accessory Struct: 0 Use Basement: 0 Tig-Tual School CET-Non Residential 09/16/2014 $224.01 Carport: 0 Additional Plan Review 09/16/2014 $400.00 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $4,303.76 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: 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 an. -I 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 issuanc work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 9. •r 1.800.332.2344. Issued By: Permittee Signature:_ace C /* 175 by 7:00 a.m.for the next available inspectio ate. This permit card shall be kept in a conspicuous place on the job site until co F.letion of the project. Approved plans are required on the job site at the time of each•nspection. • ,Puiidin2 Permit Application Commercial RECEIVEF) I011t,ll l( 1 1 til ().l , City g of Tigard ReceiDate/B ved V 46 W t Permit No.: ' 114 '4 q 13125 SW Hall Blvd.,Tigard,OR 97223 AU G 2 8 / - Plan Review ��7. a. Phone: 503-718-2439 Fax: 503-598-1960 DateB : Related Permit: T 1 G A R D Inspection Line: 503-639-4175 r (��-{i, Date Rea B ® See Page 2 for Internet: www.tigard-or.gov CITY ('^••"' i otifie. thud: f /(r/I 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(routded 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. El 1-and 2-family dwelling 'Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder 0 Other: Number of bathrooms: JOB SITE INFORMATION A.W. LOCATION Total number of floors: ,� Job site address: 1 1;66 S W ' A. New dwelling area: square feet v a 71 City/State/ZIP: 16A-440 i o& 0(1 ti23 (ie¢AJ Garage/carport area: square feet Suite/bldg./apt.#: Project name: 614317441;5••• of-p7oe Covered porch area: square feet Cross street/directions to job site: / Deck area: square feet sw f4/!/"V <�68 7/ 3 J 6 7" Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: JET# IZ225 STL I Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: .15 4.36 00 080( Indicate the value(routded to the nearest dollar)of all [� equipment,materials,labor,overhead,and the profit for the V DESCRIPTION OF WORK / work indicated on this application. r dl2. CS2e ioi — ,€ 7Z-1#22 4.� Valuation: $ /5-4 000 Ai . .65547944./s/C ,/ 5-/7..e /wit/A)4 /�4V6 4//.-1L' Existing building area Ls!a square feet New building area: 39,3 square feet / PROPERTY OWNER I ❑ TENANT Number of stories: r 2.) Name: Tx---. 6Xer11/ZO T MPVI-` , Type of construction: `V! Address: its-Z4. SW �-/i yy ,P ifb)( / n'77'oW Occupancy groups: City/State/ZIP: n b�,0 tA. 97eZ?3 r O��/v Q'` Existing: g Phone:(5)3) (oc 30,y Fax:(503) 6 3 I $agl O New: Fj RAPPLICANT CONTACT PERSON BUILDING PERMIT FEES* Business name: ,rA//M7 / /�je�T1/�L� review refsrdeeosit):u&) nA/4w l L _ Structural plan review fee(or deposit): Contact name: Z�7"'� rJ7'r �.� Address: /Pd �x 6 6V FLS plan review fee(if applicable): City/State/ZIP: /aa✓!/�'Lrd� az_ F702-0 Total fees due upon application: Phone:( ) u Lem t Fax::(c3) 77C 9 0/3 Amount received: d3 q4' E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* lmEinitC ardsifeduce�w4c?We'.xf CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: jQ e- 6/1'10-e✓ /4/4,e3,7%1‘50/77. ,'sp ,7%1t C-0 Submit two(2)sets of roof plan with connection details opp 6v)4 I a and fire department access,along with the 2010 Oregon Address: //r 9 SA/ ‘•7N / fv// 133 (';/0 1(%, Solar Installation Specialty Code checklist. City/State/ZIP: -176,00_,0/ 02 g72 Z3 q 70Zo) Permit fee(includes plan review $180.00 and administrative fees Phone:( rp3 �D�) e�t�6 3�y Fax:(D J) 3 WQ State surcharge(12%of permit fee): $21.60 CCB Lic.: 5"7 69-2. 91541( 7 Total fee due upon appication: $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: Ati r ‘..,,,,5 Date: 7f21/0y * Fee methodology set by Tri-County Building Industry i Service Board. I:,Buil ding,Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 44046I3T(1 I/02/COM/WEB) 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT • . ■ Accessibility: Barrier Removal Improvement Plan Commercial & Multi-Family - Additions or Alterations T l G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov 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 percent(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.04/21/2014 City of Tigard IN ■ COMMUNITY DEVELOPMENT DEPARTMENT T[G A R D Building Permit Review — Commercial - With Land Use Building Permit #: Pao/Vl po.0203 Site Address: ( ( 5Y c S CO G `71.1 Suite/Bldg#: Project Name: '« ��I� (Name of commercial business occupying the spa If vacant,enter Spec Space.) Gat° Planning Review _ Proposal: FX TEX-((771 j` //V7t le,glAtCct co/AprcY �e0 51�` AD�(7'I A/ , l Verify site address/suite #exists and active in permit system. d Use Case#: t14MI) 2 0/1-1 000 f 7 Plans Match Approved Land Use: ❑ Site Plan ❑ Landscape Plan ❑ Other: ❑ Urban Forestry Plan ti ❑ Elevation Plan f Building Height: --0014. Maximum Height tic Actual Height 32 — . ❑ Conditions Met: ❑ Prior to Submittal .Prior to Permit Issuance • gets) Pt Notes: C J/77 40-7,) / — 5( , d( � v z - t s>%/.0,...L.-..7 Approved by Planning: Date: g' "Z --/1 f Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittgl Original Submittal Date: q701(7/4( Site Plans: # Building Plans: # Building Permit#: d�G,�1~;nter building permit#above. ,� Workflow Routing. Planning —ngineering .Li- ermit Coordinator lBuilding Workflow Sign-off: ' -off for Planning(include notes from planning review) Route Application Documents: Building original permit application,site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: Qi aget,A4A-4-14 Date: V/alier, 1:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_042914.docx y Engineering Review ❑ Actual Slope: ❑ PFI Permit#: ❑ Conditions Met Notes: /Jo eAkQc4 ik4-0Z Ln)`ft p A S 0-,ES Approved by Engineering: Date: 63,ZAS - iii Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Permit Coordinator Review ❑ Conditions Met- Prior to Issuance of Building Permit Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: K to Issue Permit Approved by Permit Coordinator: 4/ Date: 9 3 �41 1:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_042914.docx / FOR OFFICE USE ONLY—SITE ADDRESS: This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 1111111 . II r Transmittal Letter a e e I 1 k;,\It i) 13125 S ' ,all Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: DATE RECEIVED: DEPT: BUILDING DIVISION . FROM: Yl l ��YU�� COMPANY: __ff_ PHONE: v�z_9 - 2A� lA RE: un 4,419o/V-eiooqo 3 (Site Address) (Permit Number) (Project name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: I Description: Additional set(s) of plans. Revisions: Cross section(s)and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other(explain): n REMARKS: U,p -Lj G'ck,L1jr \(fi -t dr' _ At .. 4. g, /__ ,.._,,,d/ . FOR OFFICE USE ONLY Routed to Permit Technician: Date: G(((S( (4-. Initials: ,V,,,, Fees Due: El Yes ❑ o Fee Description: Amount ue: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012