Permit _ .t
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2015-00254•
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Lolli&Pops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Remodel of existing tenant space.
Contractor: RETAIL CONTRACTING GROUP INC Owner: PPR WASHINGTON SQUARE LLC
33671 820TH AVE PO BOX 847
ELENDALE. MN 55042 CARLSBAD, CA 92018
PHONE: 612-294-6105 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 09/29/2015 $1,619.35
Demolition
Occupancy Grp: M Occupancy Load: 57 12%State Surcharge-Building 09/29/2015 $194.32
Dwelling Units: 0 Plan Review 08/24/2015 $1,052.58
Stories: 0 Height: 0 ft Plan Review-Fire Life Safety 08/24/2015 $647.74
Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 09/29/2015 $351.00
Value: $185,000 Info Process/Archiving-Lg$2.00(over 09/29/2015 $20.00
11x17)
Info Process/Archiving-Sm$0.50(up to 09/29/2015 $10.00
Floor Areas: 11x17)
Metro Const. Excise Tax 09/29/2015 $222.00
Total Area: 2114
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4.116.99
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes 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 u•h 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
Iss d By: • ' Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available ins ection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the pr .
Approved plans are required on the job site at the time of each inspection.
Burk!"Permit Applit > E I1 VEp
Commercial I'OR OFFl( 1. l 'I 0\I.1
City of Tigard received Permit No.:
13125 SW Hall Blvd.,Tigard, cr2`/34 2015 Date/B : g J� 1°ac/5'� 5"'r
IIPI Plan Review .
Phone: 503.718.2439 Fax: Q3.598.1C960 Date B `'1i �� Other Permit:
T I G A R D Inspection Line: 503.639.4,] r OF'
1I V A I�V Date Ready :y: � � ® See Page 2 for
Internet: www.tigard-or Notified/Method: �� Supplemental Information
1I!DING MI lq �
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 0 Commercial/industrial Valuation: $
❑Accessory building E3 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9642 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:G12 Project name:Lolli and Pops Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
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.
T.I.-Remodel of(E)retail space including doors,partitions,fixtures, Valuation: $5185,000.00
millwork,ceilings,etc. Existing building area: 2114 square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: Lolli and Pops Type of construction: IIB
Address:49 Powell Street Occupancy groups:
City/State/ZIP:San Francisco,CA 94102 Existing: M
g�
Phone:(415)445-4501 Fax:( ) New: M
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer tojeeschedule)
Business name: Permit Resources
Structural plan review fee(or deposit):
Contact name:Mary Ryan
Address: P.O.Box 3749 FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: Mission Viejo,CA 92690
Phone:(949)582-3735 Fax: :(949)768-8436
Amount received: t, 700) 17')'."
E-mail:many a;permitresources.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR /�,, Gk ea roof-top mounted Photo Voltaic Solar Panel System.
Business name: .A ,(p Ee 1 A/ L (le,x.)-(l 1 eTrn10 (G '&L f Submit two(2)sets of roof plan with connection details
zU`L and fire department access,along with the 2010 Oregon
� Address: 3 J 7( ` ? Solar Installation Specialty Code checklist.
City/State/ZIP: t(k fj"ail Li, H 1. 50y y Permit fee(includes plan review
$180.00
and administrative fees):
Phone:019") ALI ' Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 00 qqp `119411 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Mary Ryan Date:8/21/15 ' Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-461 3T(1 I/02/COM/WEB)
City of Tigard
III M COMMUNITY DEVET.OPMENT DEPARTMENT
■ ■
I c�n lz D Building Permit Review — Commercial - No Land Use
Building Permit #: ? 'u,P 1 S -OO aS y
Site Address: ci Loge), PLO L / /061-6t\-) 64. Suite/Bldg#: C( 2
Project Name: Lo LL 1 °i Pb PS
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /NY"d is 12 (I RE 7? (;ft tat Le..)$/'y1
K)
Existing Business Activity: l fl
Proposed Business Activity: (Z2�'�
AVerify site address/suite# exists and active in permit system.
❑ River Terrace Neighborhood: ❑ Yes tg. No
❑ Zoning: WI I(
❑ Permitted Use: X Yes ❑ No ❑ Spec Space
1. Confirm no land use required.
❑ Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: Date: gi' 2(4 — tS
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: 4 /K.
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing -Er Planning ermit Coordinator — ii lding
Workflow Sign-off: Er-Sign-off for Planning(include notes from planning review)
Route Application Documents: uilding. original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technicia : Date: q oy/c
1:\Building\Forms\BldgPermitRvw_COM_NoLandUse_0709I 5.docx
•
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
%illt)K to Issue Permit
Approved by Permit Coordinator: Date: /Z,5/S
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx
CITY OF TIGARD FEE AND PAYMENT HISTORY
I it 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
BUP2015-00254 - 9642 SW WASHINGTON SQUARE RD G12, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-Additions,Alterations, 230-0000-43104 $1,619.35 $1,619.35 $1,619.35
Demolition
12%State Surcharge-Building 100-0000-24001 $194.32 $194.32 $194.32
Plan Review 230-0000-43106 $1,052.58 $1,052.58 $1,052.58 8/24/15 Check 202290 $0.00
Plan Review-Fire Life Safety 230-0000-43108 $647.74 $647.74 $647.74 8/24/15 Check 202290 $0.00
DC Provision Review, COM TI- Ping 100-0000-43112 $351.00 $351.00 $351.00
Info Process/Archiving-Lg $2.00(over 230-0000-43135 $20.00 $20.00 $20.00
11x17)
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $10.00 $10.00 $10.00
11x17)
Metro Const. Excise Tax 230-0000-24010 $222.00 $222.00 $222.00
Totals for Fees $4,116.99 $4,116.99 $1,700.32 $2,416.67
Receipt# Payment Method Check# Payor; Receipt Date Receipt Amount
202290 Check 23070 Permit Resources Inc 08/24/2015 $1,700.32
Total Payments: $f,70177 --,.�
Balance Due: C $2,416.67 /
PERMIT RESOURCES, INC TRANSMITTAL 1 2015
To: City of Tigard Bldg. Dept. Date: Wednesday, August 19, 2015
13125 SW Hall Blvd.
Tigard, OR 97223 Project: Lolli and Pops @ Washington Square
9642 SW Washington Square Rd., #G12
ATTN: Debbie Adamski—Permit Tech Tigard, OR 97223
P/C#:
No. of Copies Description of Item
3 Sets of bldg plans
2 Sets of mechanical plans
1 Set of completed applications
1 Check for plan review fee
1 Return envelope
X For Review& Approval For Approval: Please Return For Your Use
Other For Field Use
Comments/Special Instructions:
Hi Debbie,
As discussed, all of the above enclosed for the Lolli and Pops store at Washington Square.
Please send us a plan check receipt in the envelope provided and let us know when the reviews have been
completed.
Thanks,
Mary B. Ryan
Encl.
P.O Box 3749,Mission Viejo,CA 92690 Ph:(949)582-3735 Fax:(949)768-8436
Email:info @permitresources.com website:www.permitresource.com
CHU DELIVERY NO. 908535
1431 NW 17th Avenue pe Po rtland, OR 97209 / "� DATE 09/16/15
503-227-3424 r /]t 1�o / ' '� -c
l WO# P908535
o DELIVERY TICKET o Contact# 26000
a ATTN: Debbi Adamsski
Delivery/Shipping c City of Tigard Permit Center
13125 SW Hall Blvd.
Tigard, OR 97223
IIIIIIIIIIII1111111111111111111111111111 JOB DUE: 09/16/15 at 16:00
CONTACT PHONE PURCHASE ORDER# SALES REP
Trevor Huffaker/BID SERVICES 5032273424 Kaye Kloster
JOB# JOB NAME BILLER LOC
395-005 Servy Nava 040
:f3P�..::ii�lpi�:'::::[:i:::::::::<::::::::: :`::::::E::[:[z:::::;z::::0� i�'�?1'i�ti�f::::: '::::`::;[::::: ::: ::::E::E:::::EE:EEE::E::::>::::>::. •� :::E'�. �!1 :::::-:E:>::::::E:::? '�'•:>,,.,:.,:.,.,.,..,;,:........::E::::(:::(::#lM::: ::E:Ez:.........::::>::::> ::::::::AtIf,I�`::::::::
2 complete sets of all documents.
Full Sze
LDD:
2 Copies
Edge bind
SDC:
2 Copies
Single Sided
Black and White
SLN
SUB TOTAL DISCOUNT SALES TAX TOTAL DEPOSIT BALANCE DUE
TERMS:
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
9642 SW WASHINGTON SQUARE RD G12,
TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - C of O
BUP2015-00254
Jeff Grove
Violation Summary:
Inspector Contractor