Permit CITY OF TIGARD BUILDING PERMIT
It • COMMUNITY DEVELOPMENT Permit#: BUP2015O0250
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2015
Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10145 SW WASHINGTON SQUARE RD TGI
Project: Spirit Halloween Subdivision: SPRUCE VILLAGE Lot: 5
Project Description: TI for new tenant. ADA ramp construction and interior demolition.
Contractor: DIRTY WORK Owner: PPR SQUARE TOO LLC
12369 S NEW ERA RD PO BOX 847
OREGON CITY, OR 97045 CARLSBAD, CA 92018
PHONE: 503-720-7558 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Coast: Vg DC Provision Review,COM TI-Ping 08/24/2015 $88.00
Occupancy Grp: M Occupancy Load: 134 Permit Fee-Additions,Alterations, 08/24/2015 $377.90
Demolition
Dwelling Units: 0 12%State Surcharge-Building 08/24/2015 $45.35
Stories: 1 Height: 0 ft Plan Review 08/24/2015 $245.64
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 08/24/2015 $151.16
Value: $20,000 Info Process/Archiving-Lg$2.00(over 08/24/2015 $2.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $910.05
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. • Nil*'. • egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Tho e rules are se -t f R•
95 101-0010 through OA' •52-1 -Os=O. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 0332.2
/f q
-uedBy: / Permittee Signature: ✓//
Call 503.639.4175 by 7:00 a.m.for the next availab- = on date.
This permit card shall be kept in a conspicuous place on the job site until comp • on of the project.
Approved plans are required on the job site at the time of each i -pection.
' Building Permit Application
Commercial cC � IOR(11 I 1t f 1 H (rvI v
City of Tigard RG DateB� n /4 /r _ /�u n _ ,�,� �j�
Y:r-. � � �'f'� Permit No.: /'( P�V I S"'[ilA7 V
• 13125 SW Hall Blvd.,Tigard,OR 97223 '15 VV ('F' Cv/
11 t 20 Plan Review f, •' . Phone: 503-718-2439 Fax: 503-598-196*Ull 1 Date/By: �� C� Related Permit:m/0 /iis of 7
I I,, .,I;a Inspection Line: 503-6394175 .T1 ��p Date Ready -y: June: El See Page 2 for
Internet: www.tigard-or.gov crr( O G 0' sZON Notified/Method: JJ/'//5,�� Supplemental Information
. 1 N
El New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rotnded to the nearest dollar)of all
'Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
❑ 1-and 2-family dwelling ('Commercial/industrial Valuation: $
ID Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
Total number of floors:
Job site address: (r / c c 4, (,...,-w;- , • ,7C, New dwelling area: square feet
City/State/ZIP: 4 („_„/ V l K C 7b 'Z'3 Garage/carport area: square feet
Suite/bldg./apt.#: I Project name:ff.•„,4 /.. 1 t.y,,,,,�.,.. Covered porch area square feet
Cross street/directions to job site: ! Deck area: square feet
0(G( f 6-_T t- t cf L.-7 s rg fit -' , Other structure area: square feet
ILEQULRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: Indicate the value(minded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
i'' work indicated on this application.
Pa V•. [)' a 0 G f't- $ 424 t_ ,• • Valuation: $ ��►o t::„„,
Ad Qc ,� A T� d ?4---1-4,Gtc,��� Existing building area square feet
!T l t l�/� New building area: square feet
Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( 1 Fax:( ) New:
APPLICANT ❑ CONTACT PERSON
Business name: I), ,/—L.t
j G��,_r Structural plan review fee(or deposit):
Contact name: G �.`. i CC 5 es ��
Address: , 1 3 6 r 1 s� u l FLS plan review fee(if applicable):
City/State/ZIP:. . C, c 2 C 7 C �' Sr' Total fees due upon application:
Phone:(ce5) 7 Z G' 7 S f g J Fax::( )
Amount received:
E-mail: • t` jti. c C c ( , a ''�....____
Commercial and residential prescriptive installation of
CONTRACTOR . roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: C Solar Installation Specialty Code checklist.
City/State/ZIP: J Permit fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) o
Q� State surcharge(12%of permit fee): $21.60
CCB Lie.: //15 `' �' 3 / / — Total fee due upon application: $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:)? (.1. ‘ 1, S t!J a.`- Date:r-17 - / * Fee methodology set by Tri-County Building Industry
y Service Board.
I:Building\Permits\BUP_COM_PertnitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
• A
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
I
illig
• Accessibility: Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
1 ►""\I`I) 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] $ 201 Ov 0
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ �t v v J
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: $ C( C?U v
(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_PermitApp.doc Rev.12/18/2014
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
il " Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
k.' I) 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\Pemrits\BUP_COM_PermitApp.doc Rev.12/18/2014
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
" 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
'1 ype of Su rnittal o ans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit '.
(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
71 City of Tigard
i
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Commercial - With Land Use
Building Permit #: atiPc20/s cod.
Site Address: "€ihe/Bldg#:
Project Name:
(N c of commercial business occupying the space. if vacant,enter Spec Space.)
Planning Review (, 41'/J Proposal: / r Pic ) e
IlQ Verify site address/suite#exists and active in permit syste .
Pr/and�'ver Terrace Neighborhood: ❑ Yes ll" No
P and Use Case#: /r//60Q/S-: 0000'4
Orr Plans atch Approved Land Use:_
It Site Plan / it andscape Plan ❑ Other.
JA ' rban Forestry Plan ,/tlevation Plan
I'! :uilding Height: Maximum Height ' Actual Height /5�'
,, ''onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuan
14 Business Licen
Exists: Yes ❑ No,applicant notified to obtain business license
Ai/Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified V No Applied For ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: - ��� if.AZ , Date: �'
Revisions (after Building Submittal only) Reviewer bate
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: l /S
Site Plans: #
Building Plans: #
Building Permit#: nter building permit#above. ��
Workflow Routing: 0� [ning ❑ Engineering ❑ Permit Coordinator Building
Workflow Sign-off: �S. for Planning(include notes from planning review)
Route Application Documents: �g, original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: t77
By Permit Technician: r Date: 8-7/9//5—
(:\Building\Forms\BldgPermitRvw_COM_W ithlandUse_070915.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(not typical on SDR/CUP)
❑ 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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_W ith LandUse_0709 I 5.docx
III , 41 Building Division
Over-The-Counter (OTC) Building Permit
TIGARD Check List
Projcct Description: —1--(
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: V `Cr Occupancy Group: Type of Construction: _
Type of Use**: (0-)V. Occupancy Load: Mkt._ ,
, Oregon Specialty Code: (4–
SPECIFICS
Number of Stories: ` Buildin. Hei'ht: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT-SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accesso Structure: Covered Porch:
Basement: Gara•e: 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: L ,„� 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: $ 2-01 0SC) FEES DUE
$ [ DC Prov Rvw,COM TI–Ping
$ .9'0 Permit Fee–Add,Alt,Demo
—
DC Provision Review Fee for COM TI(effective 7/1/2015) $ •vo ,te 12%State Surcharge
Project Valuation $ 1•:M Plan Review,Structural
Up to$4,999 $0.00 $ (/'(. Ie Plan Review,Fire Life Safety
$5,000-$74,999 $88.00 $ -2 /? ) Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $220.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $351.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
$ _ Cher:
Building Staff: $ Othe .
Date/Time: $ cto,CJ'D TOT FEES DUE
*TYPE OF USE: COhi=commercial;CMS=commercial manufactured structure. --
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=access iirdwelling unit ACF alteration;DEM=demo;NEW=new;
Other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070115.docx