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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT III ■ Request for Permit Action V 941 i I , 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or.gov 9,4 g g � TO: 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: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) /9- Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 4—CANCEL___ZERMIT 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#: Ada X 020/ a )5 Site Address or Parcel#: Project Name: Subdivision Name: Lot#: EXPLANATION: -I/O/E 1iT T /2�' 62 c.(/i = /4 ,d//, ,JO PE e_.0 4-1-- -C — Signature: 10 P _„ammulge Date: 4 /S Print Name: — ,j-.,/„/e.9 / J E Refund Policy 1. 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 ONLY Route to S s Admin: Date 3 $© B %!- Route to Records: Date B i = Refund Processed: DateA/ - B ■ 0 Invoice Processed: Date By Permit Canceled: Date 3 //S By.(z -- Parcel Tag Added: Date By I:\Building\Forrns\ReqPermitAction_692.114.doc s Building Permit Application 1 0 '3ft/i5 Commercial NOISIAIa owning aEIV II JO A110 I1,Il 01 41( I l `NI (►NI 1 City of Tigard Received rI vv �,u Date/By: 379 /SS Permit No a fa2D/l-- � 13125 SW Hall Blvd.,Tigard,OR c6 6 8VI'1 Plan Review I Phone: 503-718-2439 Fax: 503-598-1960 Date/By: Related Permit. T I G A R D Inspection Line: 503-639-417n 3A 13^3 8 Date Ready/By: .1,0—� H See Page 2 for Internet: www.tigard-or.gov ,\ J Notified/Method: / 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(rounded to the nearest dollar)of all ig-Addition/alteration/replacement El Other: _ equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I-and 2-family dwelling ❑Commercial/industrial Valuation: $ `� Number of bedrooms: ❑Accessory building antli ti-family y_/VLEj4 ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /4-5q P S t tl K* "" New dwelling area: square feet City/State/ZIP: -'S7/4_.4�\ 0k. 1'7 1 "5 Garage/carport area: square feet Suite/bldg./apt.#: Project name: $R� �` Covered porch area square feet Cross street/directions to job site: Deck area: square feet %el , a` � i:�_,,airIish �- r �..�����R Other structure area: feet REQUIRED DAT .COMMERCIAL-USE ' ECKLIST Subdivision: Lot#: Permit fees*are b..-1 on the value o •- ork performed. Tax map/parcel#: 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. r Valuation: $ 4 Sim , S'1 ,_ /;7 1rV A i WS 7 k.�; Aa<i 'rya/F-/ Existing building area square feet ^^may New building area: square feet 49-PROPERTY OWNER I El TENANT Number of stories: Name: Type of construction: U' Address: V (t'O 7 5ce/ r3 3 T• g��.�..'. .„ ..,..,:� -- '• cbpancy groups: City/State/ZIP: 7 y40 G �7}--j Existing: 11 Phone:(5c.)- ) Incl..- v-2_y O Fax:(.SV3 ) )a /t/ya New: a-APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* _ (Please rya toheschedule) Business name: Rk-L: .Le ,4. 7„�„/Jii )p1y� 7 �`� / Structural plan review fee(or deposit): Contact name: e�T X2 11 v � l� _ FLS plan review fee(if applicable): Address:n•d #. b•-/.5"--- ( Total fees due upon application: City/State/ZIP: pp-7t,t,fry Phone: Amount received: ) i(cC t'-Q RY,- Fax: ( ) E-mail: D�L:�glt LL„�f r'�(�0 t7aa t C�yt • PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* l� !!�' CONTRACTOR Commercial and residential prescriptive installation of roof-top mounted PhotoVoltaic Solar Panel System. Business name: CL 4 Ale 77n'" it t/f� Submit two(2)sets of roof plan with connection details ` and fire department access,along with the 2010 Oregon Addressnt 0 ,.- o��� Solar Installation Specialty Code checklist. // Permit fee(includes plan review City/State/ZIP: �j��G�'N� pi/� 9 7��� and administrative fees): $180.00 Phone:i..3) .,5-/_pd_cj.. Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lic.: Lfe& 3 7 (4"/Q*.`//, 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: �/ ,q,� Date: * Fee methodology set by Tri-County Building Industry G � (li2r 1�' '� ^�l Service Board I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT • Accessibility: Barrier Removal Improvement Plan Commercial & Multi-Family - Additions or Alterations T I 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_PemritApp.doc Rev.12/18/2014 A City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT " Plan Submittal Requirements Commercial & Multi-Family - New, Additions or Alterations T I G 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. ❑ 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. ADDITIONAL INFORMATION AS FOLLOWS: A. Fire Department Building Survey with (1) additional full set of architecture drawings. I:\Building\Pemvts\BUP_COM_PermitApp.doc Rev.12/18/2014 a I City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 1,1 • Plan Submittal Requirements Matrix Commercial & Multi-Family - New, Additions or Alterations r t n lr o 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 2 (site plan is required showing location and square footage of all buildings to be demolished,erosion control plan and tree protection,if applicable) 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 Solar Photovoltaic 2 (Requires check list for prescriptive installation. If not prescriptive installation,engineering is required.) 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.12/18/2014