Permit CITY OF TIGARD BUILDING PERMIT
• COMMUNITY DEVELOPMENT Permit#: BUP2014-00210
Date Issued: 05/11/2015
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S133DA07200
Jurisdiction: Tigard
Site address: 11470 SW 130TH AVE
Project: Summer Lake Park Restroom Subdivision: AMART SUMMER LAKE Lot: A
Project Description: Erect pre-engineered modular block restroom facility
Contractor: ROMTEC INC Owner: TIGARD, CITY OF
18240 NORTHBANK RD 13125 SW HALL
ROSEBURG, OR 97470 TIGARD, OR 97223
PHONE: 541-496-3541 PHONE: 503-639-4171
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: NEW Type of Const: Vg DC Provision Review,COM TI-Ping 04/01/2015 $75.00
Occupancy Grp: U Occupancy Load: DC Provision Review,COM TI-LRP 04/01/2015 $11.00
Permit Fee-COM-New Construction 04/01/2015 $427.58
Dwelling Units: 0 12%State Surcharge-Building 04/01/2015 $51.31
Stories: 0 Height: 0 ft Plan Review 04/01/2015 $277.93
Bedrooms: 0 Bathrooms: 2 Info Process/Archiving-Sm$0.50(up to 04/01/2015 $40.00
Value: $36,000 11x17)
Floor Areas:
Total Area: 202
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $882.82
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 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: Per ittee Signature:
3.639.4175 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 RECEIVED I Ol■ t)I I It I I 'l ()\11
Received o /�
City of Tigard Date/By: 9 OJ Permit No.: 4 494,, e��.4.
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review G rr�+��-�+
Phone: 503.718.2439 Fax: 503.598.1960 p Q q(j�� Date/By: �j (r fj ( Other Permit: t5lT�plt,Q�p�
1 I G A k h Inspection Line: 503.639.4175 5 f e LU Date Ready/By: / tom' ® See Page 2 for
Internet: www.tigard-or.gov N ified/Method: 7 /T�� y Supplemental Information
CITY OUTWARD '
TYPE OF V IN °DMSI0 . i,!i D 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: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: .I Number of bathrooms:
JOB SITE INFORMATION AND LOCATION ii77U .) Total number of floors:
Job site address:Smarms—bib-Park at teravR.•. I a1[eview Terrace , I�O�i New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Summer Lk.Park Restroom Covered porch area: square feet
Cross street/directions to job site:Head westbound on Walnut St from Hwy 99W Deck area: square feet
Head northbound(rt)on 128th Avenue to intersection of Winterlake Dr.Head east Other structure area: square feet
(rt)on Winterlake Dr.take left on Lakeview Terr. Site located at end of road. REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:N/A I Lot no.:N/A Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1S133DA07200 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.
Erect pre-engineered modular block Romtec restroom facility Valuation: $$36,000.00
on concrete slab Existing building area: n/a square feet
New building area: 202 square feet
0 PROPERTY OWNER I ❑ TENANT Number of stories: 1
Name:City of Tigard Type of construction: VB
Address: 13125 SW Hall Blvd Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)718-2466 Fax:(503)624-0752 New: U
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:City of Tigard (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Jeff Peck
FLS plan review fee(if applicable):
Address: 13125 SW Hall Blvd
City/State/ZIP:Tigard,OR 97223 Total fees due upon application:
Amount received: _ —��,
Phone:(503)718-2466 Fax::(503)624-0752
E-mail:jeffp @tigard-or.gov PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-t.: mounted PhotoVoltaic Solar Panel System.
Business name: QA M TZ ._,,./,./11___,_,C Submit two of roof plan with conne .: u etails
1r-- — and fire department ace- • ong wi • e 2010 Oregon
Address: f p.,2 w) Ahlie#716,9-n/ _ Solar Installation Specialty G•• -•-cklist.
7 0 Permit fee(inclu., plan review $180.00
City/State/ZIP: C
21���(42� 6'J 4,—
and .: inistrative fees):
Phone:(5V I % 1/9( _ 3s iii I Fax:(� State sure•: ge(12%of permit fee): $2 ..
CCB lie.: [ /9 ..5":f- /h//
// I otal fee due upon application: $201.60
Authorized signatur This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Z 1_t✓l= t€c_._. Date: 9 _13 _ 14 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
City of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
T►c n n Building Permit Review — Commercial - No Land Use
Building Permit #: o(, O/Ll •-CAD o2-i O
470 W t3
Site Address: lk:4 IS 133UPt (Y7 d 00 Suite/Bldg#:
Project Name: 61,1 mr,erIA-KC iadc-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: C G r l j i—r t,.GF re d C ' 4 � I 41 i n ub(<< pct.-Lc •
Existing Business Activity: t'1/c
Proposed Business Activity: /eLd
kr Verify site address/suite #exists and active in permit system.
Zoning: FR
APermitted Use: Yes ❑ No ❑ Spec Space
Confirm no land use required.
Notes: Qu,(eV, rS riliC;•'Y7G k(`� c?Ol1 S • -Iet '
M0 4%, loo - cri. w ,.5 $dr..kc 4.ie •
Approved by Planning: C' _" D a • D��-i Date: 9 -8 -/ 7
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: Wg//cl
Site Plans: # /OM
Building Plans: # ,3
Building Permit#: 12(Enter building permit#above.
Workflow Routing: � P nning Permit Coordinator ..0'Building
Workflow Sign-off: A Sign-off for Planning(include notes from planning review)
Route Application Documents: 1:1-1 ding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician:CA_) QO J Date: 9.%A‘
I:1Building\Forms'BldgPermitRvw COM_NoLandUse_071514.docx
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:
OK to Issue Permit
•
/ I N /
Approved by Permit Coordinator: /`/ Date:
1:\Building Worms\BIdgPermitRvw_COM_NoLandUse_071514.docx