Permit Mil City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT \/ 0
Request for Permit Action i�/y//y
F!c;A i I) 13125 SW Hall Blvd. • Tigard,Oregon 97223 . 503-718-2439 • www.tigard-or.gov
'I 0: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov
FROM: p Owner ❑ Applicant p Contractor $City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) /(4'
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CAN-CET/ ID PERMIT O
ERMIT FEES (attach APPLICATI copy of orN.iginal 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#: (J4.Pao/4-ex)a7 7
Site Address or Parcel#: '"�6 sp 6.0.-iJ E3 f_t_04 1,3-h It aDD
Project Name: PsPt y C f} K
•
Subdivision Name: Lot#:
EXPLANATION: A pp L,o A nyT LO#S a J ) cogo,J,,, .r r Av ss,
n_Q 2s r A--6-t)Qtz- 15 i,3 - --6t.4t.)tTbfJ tS rte ue t s'�,err e.,,, , AJO
L4 10 3t e L 1 e •
Signature: to-444...A Date: //A /�5/
Print Name: t46/i. L A "cyA'E /cj-
Refund Policy
I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ON I 1
Route to S s Admin: Date /zzymawrli Route to Records: Date t AMEIEMVAIII
Refund Processed: Date , ,GAIMLIVEMI Invoice Processed: Date B
Permit Canceled: Date /a/y /y/ By 1''7 Parcel Tag Added: Date By
L:\Building\Forms 1RegPermitAction_09231,.doc
•
1
Building Permit Application V 0 I D /.2,///y 02(74-
Commercial RECEIVED FOR OFFICE USE ONLI
Receiv_•Mri ff� L , •I'/-O L 79
City of Tigard Permit No..
`J g q DateB � •--
--" 13125 S W Hall Blvd.,Tigard,OR 9722N Q V 2 5 2O�4 Plan Review
Phone: 503-718-2439 Fax: 503-598-196
Date/By: Related Permit:
T I GA R Il Inspection Line: 503-639-4175 `( (1(, a{� Date Ready/By: Juris 65 See Page 2 for
Internet: www.tigard-or.gov C11 V■ l'l( A `D Notified/Method: Supplemental Information
7,ING pIVIcl{e*
- r'
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(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 I .(ommercial/industrial Valuation: $
❑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: .(16*0 SvJ 1 1 w,t--DC) , ' j New dwelling area: square feet
City/State/ZIP: w. -e-s0 01r p., Garage/carport area: square feet
Suite/bldg./apt.#: Project name: } i o K f.�( Covered porch area square feet
Cros street/directions to job site: h J� �� I _ Deck area: square feet
Ni?... /"f PPZ/ CI�V it LOQ�i '%-Tit '�,Cr' Other structure area: square feet
A��Q�S6 /6 ; /t'O� , t HPU , ? tk — REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: t4 4 :7--- .3'c, tuf2l 3D I CTo,40t 4: Permit fees* are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Op
tt�E.L. �xµvvx�{ZLmW,� �∎�,- . \� Valuation: $ SG 1-kb
Ce.\ 1T Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( Fax:( ) New:
124PPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: F t�r_ r�4Za►-' ��
(Please refer toles schedule)
Structural plan review fee(or deposit):
Contact name: t.t(C. e
_
Address: ,�3?jt.t � {r �.�!�Lt l��(rl�l FLS plan review fee(if applicable):
(t
City/State/ZIP: �b\7�t'i.tAp�0 c Q7 i zz-5
Total fees due upon application:
Amount received:
Phone:(ep3) 6 'S. ---4 4, Fax::(,'3) -lf-Ki-— ,3c
E-mail: &\Yie e �res-r-G �P i!K� �`j`5_ co vt� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive instal. 'on of
roof-top mo :1 PhotoVoltaic Solar P. = ystem.
Business name: Nj� '`rj l S'TlALA—e'er:t,pt--S' Submit two(2)s-. of roof plan wi 1 Innection details
and fire department.- ess,alo.-with the 2010 Oregon
t
Address: b ` S • 4.-- (kj P1/4 Solar Installation Speci• • ode checklist.
City/State/ZIP: y -yam, Permit fee(in .'es .. review
y d�L'fl� CA r e-,R 9 tc)'TS ..• .dministrative : $180.00
Phone:( ) II Fax:( ) States arge(l2%of permit fee): $21.60
CCB Lic.: 074/ g
Total fee due upon appication: $201.60
Authorized signature:A/9/ ` This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: V1,\1 'Y Date: t( ( !( * Fee methodology set by Tri-County Building Industry
t Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
t
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Accessibility: Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
T 1 G A R D 13125 SW Flail 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\Pcrmits\BUP_COM_Pcrm itApp.doc Rev.04/21/2014
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
IN . .4 Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with:
A. El map& tax lot# ❑ project name ❑ site address El suite number
El 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. ADDITIONAL INFORMATION AS FOLLOWS:
A. Fire Department Building Survey with (1) additional full set of architecture
drawings.
I:\Building\Perrnits\BUP_COM_PermitApp.doc Rev.04/21/2014
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
111 " Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
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_PcrmitApp.doc Rev.04/21/2014