Permit y p CITY OF TIGARD BUILDING PERMIT
11111 s, COMMUNITY DEVELOPMENT Permit#: BUP201500070
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/24/2015
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Dominos Pizza Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: TI for existing tenant:Expanding Dominos Pizza into adjacent space,and constructing non-bearing partition walls
and(2)bathrooms.
Contractor: CHENG XIN CONSTRUCTION LLC Owner: PACIFIC REALTY ASSOCIATES
3016 SE 129TH AVE ATTN: N PIVEN
PORTLAND, OR 97236 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-970-4708 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Vg Permit Fee-Additions,Alterations, 03/24/2015 $453.95
Demolition
Occupancy Grp: A-2 Occupancy Load: 113 12%State Surcharge-Building 03/24/2015 $54.47
Dwelling Units: 0 Plan Review 03/24/2015 $295.07
Stories: 1 Height: 0 ft Plan Review-Fire Life Safety 03/24/2015 $181.58
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 03/24/2015 $8.50
Value: $24,600 11x17)
DC Provision Review,COM TI-Ping 03/24/2015 $75.00
DC Provision Review,COM TI-LRP 03/24/2015 $11.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,079.57
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes 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.
Issued By: Permittee Signature:
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.
Building Permit Application
Commercial FOR OFFICE USE ONLY
• City of Tigard RECEIVED Received 3 GI 1,1 1. .77— Permit No.: fI • �s, , d
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie•��
Phone: 503.718.2439 Fax: 503.598.1960 Date/B ��i j Other Permit:
MAR 2 4 2015
[it,:\It I) Inspection Line: 503.639.4175 Date Re R "" 7y: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Me od: 3 / /s •( 7 7-3:G Supplemental Information
BUILDING DIVISION I
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 ®Commercial/industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total-number of floors:
Job site address:15989 SW 72nd Avenue New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Dominos Pizza Expansion Covered porch area: square feet
Cross street/directions to job site:Near intersection of SW Upper Boones Deck area: square feet
Ferry Road And SW 72nd Avenue Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Expand Existing Dominos Pizza Restaurant Into Adjacent Space-Perform Minor Valuation: $$24,600.00
Selective Demolition,Construct Non-Bearing Partition Walls,Add(2)Restrooms, Existing building area: 1175 square feet
Modify Existing Mech,Elect,Plumbing and Fire Sprinkler Systems,All Per Code. New building area: 3405 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name:Dominos Pizza Type of construction: III-B
Address:3512 NE 3rd Avenue Occupancy groups:
City/State/ZIP:Camas,WA 98607 Existing: A2/Mercantile
Phone:(360)326.8864 Fax:( ) New: A2
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Dugas Design (Please refer to fee schedule
Structural plan review fee(or deposit):
Contact name:Andrew Dugas
FLS plan review fee(if applicable):
Address: 100 E.19th Street-Suite 300
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98663
Phone:(360)518-8243 Fax: :( ) Amount received:
E-mail: Dugasdesign @hotmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: 14* 2C.I frii4 ' 1 S01‘.° Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: ?a/6 S „A9 J Solar Installation Specialty Code checklist.
City/State/ZIP: /J� / Permit fee(includes plan review $180.00
f�J�24 d/ el q7 4 and administrative fees):
Phone:(SL-3) q)Q_ .t 7i)8. Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 'Ub 3 Q Z- VW j Total fee due upon application: $201.60
Authorized signature: / This permit application expires if a permit is not obtained
t within 180 days after it has been accepted as complete.
Print name:Andrew Dugas Date:03.02.2015 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
■ City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: eiNoc20/S-cx) 7d
Site Address: \5°I$q 3j 12-r>d NNia, Suite/Bldg#:
Project Name: born no 5
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: fderit^rtel — exiskin() domino, expand1.nc in-1-0 a acerr}` s ct°J
m Verify site address/suite#exists and active in permit syst .
/River Terrace Plan District: ❑ Yes M No
,,_
L� and Use Case#: M MD-2,,,01 5 .. 000 1 b
VI lans Match Approved Land Use:
$Site Plan -B-Landscape Plan ❑ Other:
-g-Urban Forestry Plan -Elevation Plan
ier Building Height: Maximum Height Actual Height
n.,n e -El-Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
IBusiness Lice se:
xists: Yes ❑ No,applicant notified to obtain business license
LJ Public Facilities Improvement F Permit:
Required: ❑ Yes, applicant was notified No Applied For: ❑ Yes ❑ No, stop intake
Notes:
Approved by Planning: : f nn Leh rbac in Date: 312.1-I i , 5
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 9 /c
Site Plans: # i /,
Building Plans: #
Building Permit#: :i nter building permit# above.
Workflow Routing: E 1h1 ping ❑ Engineering ❑ Permit Coordinator 2.--13
Workflow Sign-off: ❑ Sign-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: OTC—
By Permit Technician: /' ' Date: 1� A/B 5—
1:\Building\Forms\BldgPermitRvw_COM_W ithLandUse 031015.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments) per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date:
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
❑ 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
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse 031015.docx
P . "I Building Division
Over-The-Counter (OTC) Building Permit
TIGARI)
Check List
Project Description: I k
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: • Occu.anc Grou.: Wjf� Type of Construction: tA"1'�
T j.e of Use**: ��', Occu,an Load: MI '22 Oregon Specialty Code: 70
SPECIFICS
Number of Stories: I 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: 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: I
Total Project Valuation: $____ _Lein FEES DUE
$ If=-3,1n0 DC Prov Rvw,COM TI—Ping
$ CC) DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI(effective 7/1/2014) $ ;. Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ - 7,1z. 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ 2" • Plan Review,Structural
$5,000-$74,999 $75.00 $11.00 $ ati?�' 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 $ ',I 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: $ 0741 j7 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;
O'IR=other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070114.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
15989 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Building
299 Final inspection
PASS - C of O
BUP2015-00070
Chip Barnett
Violation Summary:
Inspector Contractor