Permit CITY OF TIGARD BUILDING PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: BUP2015-00050
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2015
Parcel: 2S102BD03200
Jurisdiction: Tigard
Site address: 13075 SW PACIFIC HWY
Project: Qush Hookah Subdivision: NORTH TIGARDVILLE ADDITION Lot: 35
Project Description: Remove several interior non-load bearing walls,create employee work station with sink&stove.
Contractor: RES DEVELOPMENT GROUP INC Owner: SANCHEZ, J GUADALUPE
14476 S BUCKNER CREEK RD ZAVALA, BLANCA E
MULINO, OR 97042 10000 SW MOLLY CT
TIGARD, OR 97223
PHONE: 503-381-2586 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 03/03/2015 $119.33
Demolition
Occupancy Grp: A-2 Occupancy Load: 65 12%State Surcharge-Building 03/03/2015 $14.32
Dwelling Units: 0 Plan Review 03/03/2015 $77.56
Stories: 1 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 03/03/2015 $2.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $3,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $213.21
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No 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 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 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.
Iss ed By: J� Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection dale. �r
This permit card shall be kept in a conspicuous place on the job site until complete of th• • eject.
Approved plans are required on the job site at the time of each inspe ti•
. Building Division
Over-The-Counter (OTC) Building Permit
TIGARD
Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: A2- Occupancy Group: j� Type of Construction:
Type of Use**: (:_e-45-20. Occupancy Load: Lf7 Oregon Specialty Code: �d(r\
SPECIFICS
Number of Stories: ` Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT-SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: _ Carport: Mezzanine:
SETBACKS
Sideyard Setback–Left Sideyard Setback–Front _
Sideyard Setback–Right Sideyard Setback–Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access.Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: 14 ) Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor:
Total Project Valuation: $ FEES DUE
$ DC Prov Rvw,COM TI–Ping
$ DC Prov Rvw,COM TI–LRP
DC Provision Review Fee for COM TI(effective 7/1/2014) $ 'iig7C,, Permit Fee–Add,Alt,Demo
Project Valuation Planning LRP $ ea, , 2%State Surcharge
Up to$4,999 $0.00 $0.00 $ 7 j� Plan Review,Structural
$5,000-$74,999 $75.00 $11.00 $ Plan Review,Fire Life Safety
$75,000-$149,999 $187.00 $28.00 $ Info Proc/Arch,Lg(over 11x17$2.00)
$150,000 and over $299.00 $44.00 $ '2, j Info Proc/Arch,Sm(up to 11x17$0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other.
$ Other:
Building Staff: $ Other:
Date/Time: $ 2 13.21 TOTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commercial manufactured structure.
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
OTR=other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070114.docx
Building Permit Application
Commercial FOR OFFI( E USE ONLY
RECEIVED dI Received g� LL ), �/�
II City of Tigard Date Permit No.: 5--ores
• 13125 h n SW Hall .2 39 Tigard,OR 98.14 pp q Plan Review ��;��� �
i Phone: 503.718.2439 Fax: 503.598.lh�R 3 2015 43 Other Permit: MI , D/5— '
DateB
TIGARD Inspection Line: 503.639.4175 Date Ready/B : Juns Eff See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
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.
El 1-and 2-family dwelling g Commercial/industrial Valuation: $
ID Accessory building ID Multi-family Number of bedrooms:
El Master builder ID Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I •1 5W PAtin G vivvv New dwelling area: square feet
City/State/ZIP: fl( ARD, 0g. °1'1223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Qt,6 1 N{JIJa.m. Covered porch area: square feet
Cross street/directions to job site: ROM 51pE Op 1iwy,gq uv6r Deck area: square feet
8€1iiWira4 F . ( ci AD (2102]2.J.TT Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: 3200 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2610 fi!<JD Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
Qom.�N ��% �,n w
DESCRIPTION OnF.,WORK
,-� work indicated on this application.
r'5'w1l , J1fiVr.IC�FtI✓IN II OR AN LOAD $ ►eNta WALLS Valuation: $ 'OOO*06
App kr r, ) Emp vv�4 ,n ` IN s` igui� Existing building area:I�'1� square feet
!t✓J/ Yw Vim" UlY New building area: 1 F14, square feet
❑ PROPERTY OWNER [ 1H(TENANT Number of stories: I
Name: KARBALA 1.4.4. •e,/s ( USN I16( kAN t1 e. EC. Type of construction:
Address: 13075 eJ.W pAUFIL t}Wy Occupancy groups: A.2
City/State/ZIP:Ti Q 4512 q722-3 Existing: ual,►Ihr.1N
Phone:(q7( ) 217-G,6(Q I Fax: ( ) New: A,2
Mil APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: IcAItl3Auk (Please refer to fee schedule
L Structural plan review fee(or deposit):
Contact name: MOHAMMED AL a t1P5ZY
13x7 PACIFIC Iv o/ FLS plan review fee(if applicable):
Address: —
Total fees due upon application:
City/State/ZIP: '1' GA:02D OI. '172,2.'
_! I Amount received:
Phone:(511 ) 24?•Sael Fax: :( )
E-mail: 1ogAllvv�Jy /�u }1•000i.cA PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
�[ Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:fish DFr. elopM J4 - ca-el 1p t, Submit two(2)sets of roof plan with connection details
Address: f_ tat Ir 1r AJ and fire department access,along with the 2010 Oregon
1 "'l 6 Dua l g , �� Solar Installation Specialty Code checklist.
City/State/ZIP: MUUNO Ofd- �� � Permit fee(includes plan review $180.00
and administrative fees):
Phone:(66) %I - 9 f„ 4 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 20.s 31$"� .
Total fee due upon application: $201.60
Authorized signature: 1( , ,. This permit application expires if a permit is not obtained
1� within 180 days after it has been accepted as complete.
Print name: A .
• �� / Date: * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
City of Tigard
III • COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: f' -u R90 15=O O (3
Site Address: /30 ..S k) Ac,;4_ /7uuiy Suite/Bldg#:
Project Name: Q4 ,j,J / OU
(Name of commercial business occupying the spa . If vacant,enter Spec Space.)
Planning Review j;
Proposal: e�efin�'� >yle /17 // •►r u r�!.•'t! t . �f "2,44-- AJ L) .C-�i,/cge-e L
S-'4-75' %J, S/Y - V� t/
I]d Verify site address/suite #exists and active in permit system.
and Use Case#: 4/mvc2o f! --0000-9-
IlQ Plan atch Approved La`nd��Use:
VIZi Site Plan St? ' neik A'andscape Plan ❑ Other:
/,1rban Forestry Plan levation Plan ,
�/$uilding Height: Maximum Height 17/S Actual Height �, /Sli
C ditions Met: CI Prior to Submittal ❑ Prior to Permit Issua
Ousiness Lice e:
Exists: Yes ❑ No,applicant notified to obtain business license
Public Facilities Improvement(PFI) Permit:, N/A-
Required: ❑ Yes,applicant was notified Ltd' No Applied For: ❑ Yes ❑ No,stop intake
Notes: S,4,' /,,,_/ _at- •.._a &I :I 0' " -- 'f( / ' b r- / 7 r
Approved by Planning: ` 14111111 �'.'1J.'!�, Date: 3-3-j --'
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: El Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 8/5--i/�
Site Plans: # 3
Building Plans: # 3
Building Permit#: 0---Enter building permit#above.
Workflow Routing: Planning ❑ Engineering 'ermit Coordinator ding
Workflow Sign-off: g--Sign-off for Planning(include notes from planning review)
Route Application Documents: 13—Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ; /„ % Date: S4/; —
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse 020415.docx
Engineering Review
❑ Actual Slope:
❑ PFI Permit#:
❑ Conditions Met
❑ NOT Approved by Engineering: % Date
Notes:
Approved by Engineering: Date:
Revisions (after Building S .mittal only) Reviewer Date
Revision 1: ❑ Ap• oved ❑ Not Approved
Revision 2: • 'pproved ❑ Not Approved
Revisio . ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
❑ Approved,NOT Released: Date:
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:
❑ OK to Issue Permit SpAApd by Pmit Coordinator: r _
✓�U ( uti /�e- 5
I:\Building\Forms\BldgPermitRvw COM_WithLandUse 020415.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13075 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - C of O
BUP2015-00050
Chip Barnett
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13075 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00050
Chip Barnett
Violation Summary:
Inspector Contractor