Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 1 .1
Ir.
Request for Permit Action 9 Os di
T I G A R D 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
"1.0: 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: p Owner ❑ Applicant ❑ Contractor ® City Staff
(:heck(✓)um
REFUND OR Name: Alvin Deighton
INVOICE TO: (Business or Individual) Rohner .
Mailing Address: 2650 NE Andresen Rd #102
City/State/Zip: Vancouver,WA 98661
Phone No.: 360-885-7641
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL/VOID PERMIT APPLICATION.
o5 "® d/TPERMIT FEES (attach copy of original receipt and provide explanation below).
far ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: BUP2015-00263
Site Address or Parcel#: 14280 SW 72nd Ave,Tigard, OR 97224
Project Name: Leif'Auto Collision Center
Subdivision Name: Lot #:
EXPLANATION: Void this permit as total scope of work reviewed under MEC2015-00597.
✓Paid fees trans - - . . : BUP2015-00263 and applied to MEC2015-00597.
Signature: •'iU _ •-• ■ IldJ J-1 Date: 9/3/15
Print Name: Debbie A.Adamski
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 ONI.I
Route to S s Admin: Date 6]nfialrIELIMI Route to Records: Date jr7Aan :; li
17 m-p—Zeftaf't1 Processed: Date - / By 4;7 Invoice Processed: Date By
Permit Canceled: Date q r/S By Y 4 `.rcel Tag Added: Date By
1:\Building\Forms\RegPemvtAction_09..314.doc
dui Idina Permit Applicati
Commercial h()R OFFICE USE ONLY
MI City of Tigard p rll,�rt, 1 Receives Penult Nu.. 1
g ~ L3 2 15 DateB : 5� Ll,tAI i �5:06,�(( .
■ 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
Phone: 503.718.2439 Fax: 5113 J Q Date/B : Other Permit:
TIGARD Inspection Line: 503.639.41751.11 I yr I1(AR(D Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.g13 f r1 19Thr,rillIrnl(n Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
El construction Ell 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: S
❑Accessory building ❑Multi-family
Number of bedrooms:
❑Master builder ❑Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 14280 SW 72°"Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Leifs Paint Booth Covered porch area: square feet
Cross street/directions to job site:Near intersection of SW 72°"Ave and SW Deck area: square feet
Bonita Rd. Other structure area: square feet
REWIRED DATA.tOI4 8 E
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 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.
Valuation: 5 2443800 i i( 14 g.o.
Install Garmat paint booth J
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name:Leits Auto Collision Center Type of construction:
Address: 14344 SW 72"Ave Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:(503)620-5343 ! la ( ) New:
® APPLICANT CO CONTACT PERSON — BUILDING PERMIT FEES*
Business name:Rohner 6. ', - '* se /
Structural plan review fee(or deposit):
Contact name:Alvin Deighton
FLS plan review fee(if applicable):
Address:2650 NE Andresen Rd.#102
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98661 ��,
Amount received: " I 1".
Phone:(360)885-7641 Fax::( )
E-mail:alvindeightonnrohner-usa.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
- =r° ,, Commercial and residential prescriptive installation •f
CON . ., _. .....,, roof-top mounted PhotoVoltaic Solar Panel Syste r.
Business name:Rohner Submit two(2)sets of roof plan with connect'• details
and fi • •artment access,along with th- 110 Oregon
Address:2650 NE Andresen Rd.#102 Solar Instal a . .•cialty Code ch-• ist.
City/State/ZIP:Vancouver,WA 98661 Permit fee(inclu• view $18000
and adminis . the .
Phone:(360)885-7641 Fax:( )
State surcharge(I '0 of permit fee): $21.60
CCB lie.: 135549
Total f - due upon application: $201.60
Authorized signature:X elep This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Alvin Deighton Date:8/25/15 * 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)