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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT III ., FEB 1 2 Request for Permit Action CIT,rY�,Bt ; . ,.ri�, TIC;;\R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.>� 4>1-0i10a 1.11VlS QN TO: CITY OF TIGARD V 0 1 1 Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 3/4/'(' 'ff' Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: IF Owner ❑ Applicant ❑ Contractor n City Staff Check(✓)one /J _ REFUND OR Name: 4� Z 0/ .� 60 W INVOICE TO: (Business or Individual) 41Aite Mailing Address: 4o g 0 5 t3 &tile/L(5:444o /e,4 City/State/Zip: l l c) A, 1/0 ) 6 9 `q-d-d--33 Phone No.: t q- I - LI l I a sm 3 3M - 8 ,t_ PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). n REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: S V Z 0 i Yr 6 O 3 Li c Site Address or Parcel #: q-oq o S� i(t ______Jeihrtvo ( 1,'gA4o1 6) q10-a-3 Subdivision Name: Lot #: ^ EXPLANATION: IA)D_ Aire U) H'/-L/an -f 04 Signature: .'t.- Date: i/7_ (i 0 Print Name: `' ja'L1/ f v- Refund Policy 1. The city's Community Development Director,Building Official or City 1ngineer 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 800/0 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 ONLY Route to Sys Admin: Date By Route to Records: _ Date _1 3 /(p B' ' Refund Processed: Date 3/3/4) By '7I Invoice Processed: Date By Permit Canceled: Date 3�V/6, By f:-I Parcel Tag Added: Date By I:ABuilding\Forms\RciPcrmit.Action_09_31 .doc . . T I GARD City of Tigard March 3, 2016 Jane Miller 7090 SW Beveland Rd Tigard, OR 97223 Re: Permit No. BUP2015-00345 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7090 SW Beveland Rd Project Name: North Point Job No.: N/A Refund Method: ® Check#220333 in the amount of$106.80. ❑ Credit card "return" receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. n Trust account"deposit" receipt in the amount of$ Comment(s): Cancel permit per applicant's request. Retain plan review fees for plan review completed and refund payment for portion paid for permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 3 A Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the RequestforPernutAction form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Jane Miller DATE: 2/25/2016 7090 SW Beveland Rd Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 400998 Case #: BUP2015-00345 Date: 12/10/2013 Address/Parcel: 7090 SW Bev eland Rd Pay Method: CreditCard Project Name: North Point EXPLANATION: Per applicant's request as job has been cancelled. Retain plan review fees for plan review already completed and refund balance of permit fee paid. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example:. Building Permit Fee Example: 2300000-43101 $Amount Building permit 230-0000-43104 $106.80 TOTAL REFUND: $106.80 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff ^/ ✓ /fie If under$12,500 Division Manager 1` If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: /3/4o By: i\Building\Refunds\RefundReyucst.doc x 09/01/2010 CITY OF TIGARD FEE AND PAYMENT HISTORY i 141 13125 SW Hall Blvd.,Tigard OR 97223 i 503.639.4171 TIGARD BUP2015-00345 - 7090 SW BEVELAND RD, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Permit Fee-Additions,Alterations, V 0 i 230-0000-43104 $487.01 $487.01 $194.80 12/10/15 Credit Card 400998 $ 4 Demolition 12%State Surcharge-Building 100-0000-24001 $58.44 $58.44 ..$, ,✓ Plan Review 230-0000-43106 $316.56 $316.56 $316.56 12/10/15 Credit Card 400998 $0.00 DC Provision Review, COM TI-Ping P+{ 1'.`1 100-0000-43112 $88.00 $88.00 " Y,>,`� $808. Info Process/Archiving-Lg$2.00(over 230-0000-43135 $8.00 $8.00 V 11x17) Totals for Fees $958.01 $958.01 $511.36 $446.65 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 400998 Credit Card Jane M Miller 12/10/2015 $511.36 Total Payments: $511.36 Balance Due: $446.65 /-'cn.--it T -E-c / 9y, P'O -4\ 2 e.P/2 — Pe• 771....f-n/S?mac-. . , f le c Building Permit Application V 0 .1 17 /0 i� IS L S Commercial RECEIVED i OR 01 1 it I I I O\I.1 City of Tigard Received / / Permit No.: j i� 3 S Date/B : �J ��}� 11 ■ 13125 SW Hall Blvd.,Tigard,0/1-37/93 8 2015 Plan R , ' `�-�� r Phone: 503.718.2439 Fax: 503. 960 Date/By: �.'A tf�\ V5 Other Permit: I I( \I:t) Inspection Line: 503.639.4175., Date R-.�'. : /_ / kris' In See Page 2 for Internet: www.tigard-or.gov CITY OF THAW) Notified/M . • /a MP l , Supplemental Information c • . 1 .. • I I I . ..i/ �•' `_F Iv TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 0 Demolition Permit fees*are based on the value of the work performed. Addition/alteration/re lacement 0��: equipment, Indicate the value(rounded to the nearest dollar)of all ` P 1 • equimaterials,labor,overhead,and the profit for the CATEGORY OF CCONXCommerciah/industrial STRUCTION wo indicated on this application. ❑ 1-and 2-family dwelling Valuatio $ ❑Accessory building ❑0 Multi-family _Number of ooms: 0 Master builder 0 Other: Number of ba JOB SITE INFORMATION AND LOCATION Total number of fl..rs: Job site address:Wei 0S♦I 1 -V P r-. G 4.-r." New dwelling area: square feet City/State/ZIP: IN � .,4 ►` r—. 22 Garage/carport area: square feet Su e/bldg. pt.no.: Z Project name:roe t' i,,` i 1 • Covered porch area: s..: . feet Cross street/directions to job site: G1,M 1 .„ ��Y�������� w/i/ Deck area: square .-t �' fj ` r , ^ eS . V Other structure area: square feet V 'v lJ�' REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: 6` I Lot no.: Permit fees*are based on the value of the work performed. 2G 1 h I �( l5 D J^O Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: aJ 1 V H LY�J equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. I w IO✓� --r{r�t�1�I �t71—• •.�}►. Valuation: $ /f /y1Q =1`� C :, ' 'i 1� / G$ I `t 1• 1 , Ille C IGV I Existing building area:2 ,20 0 square' feet ciR 5i-2Ua vicrgic p< j-t>. New building area: /J .�square feet 0 PROPERTY OWNER I TENANT Number of stories: � ,e Name: of tg y � L, ,Ary TLItER Type of construction: 3 . Address: 70 1 D ,�� 1 �v1• r1 A 1., 7 ..."-r•' Occupancy groups: City/State/ZIP:I �/'^� , A �� O�. IQ_""7'`2���- Existing: Phon Lill•'71. Fax:( ` l New: 0 APPLICANT CONTACT PERSON _ BUILDING PERMIT FEES* Business name: vkvi Q 61556"'x' ARCTI �G ( re( mjae le) Structural plan review fee(or deposit)sit):: Contact name: 1:24,A)t D 0,1556111r FLS plan review fee(if applicable): Address: !05140 R i\reGsi7D • 1 d I Total fees due upon application: City/State/ZIP: ?O p. r1 �n(c, Q'i , 97?_/.5 _ [�1 1 —� 1�• Amount received: *57, 36 Phone:�'J • 3i,.1 • 4445 I Fax::( � E-mail: 1)Avt`v)1 Q pf ^ izG' `,C.0� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* L� CONTRACTOR �L Commercial and residential prescriptive installation of roof-top . ted Photo Voltaic Solar Panel System. Business name: -r-E,_r Submit two(2 of roof plan with connection details and fire department . • ,along with the 20 • Oregon Address: Solar Installation Specis • Code chec . City/State/ZIP: 4 Permit fee(includes p - re% • $180 00 and administra i .•-s): Phone:( ) Alralaftlii State surcharge(12% • permit f-- $21.60 CCB lic.: riP7.- ' Total fee•le upon application: $201.60 Authorized• ature: � /� � 'This permi ppticshon expires ii a permit is not obtained within I.:I days after it has been accepted as complete. Print nam-: , vitt, 5 t.dietgrr Date: * Fee methodology set by Tri-County Building Industry �� Service Board. I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613 T(11/02/COM/WE B) : City of Tigard 114 COMMUNITY DEVELOPMENT DEPARTMENT II T 1 G A R D Building Permit Review — Commercial - No Land Use Building Permit #: l�. LA.p p'ZO t 5 oo 3 4 5.- Site Site Address: ?"09O &IO eleuela Suite/Bldg#: Project Name: A/497-,4f AAP"' k./e.s2/ i t SO/M 771 (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: 77/. --gr {X%S1 / A71- Existing Business Activity: OgGQ Proposed Business Activity: 1/ LVJ Verify site address/suite# exists and active in permit s�yst ��. AJ fiver Terrace Neighborhood: ❑ Yes '/J No (,( oning: Me" Permitted Use: J6 Yes ❑ No ❑ Spec Space Confirm no land use required. 'usiness License: Exists: DrYes ❑ No, applicant notified to obtain business license Notes: Approved by Planning: e== _ e Date: /8//S— 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: /st/e/i dr Site Plans: # 3 Building Plans: # '5 Building Permit#: Fs?Enter building permit# above. Workflow Routing: Planning [ --"Permit Coordinator 17 Building Workflow Sign-off: .12—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: By Permit Technici . 00Date: /Ag/f 6 1:\Building\Fonns\BldgPermit Rvw_COM_NoLand Use_0709 1 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 ,kOK to Issue Permit Approved by Permit Coordinator: .a . C Date: ID - cl — VS 1:13uildingTonns 4 • 114 Building Division Accessibility: Barrier Removal Improvement Plan TIGARD 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 per-cent(25%). VALUATION: Total of all renovation,alteration or modification being done,g �Q excluding painting and wallPa erin 1 P [ ] $ �-r!J MULTIPLIER(25%barrier removal requirement): x .25 TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ `7`pp© 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 $ 14A i (b) An accessible entrance: $ V I • (c) An accessible route to the altered area: $ G_____ 6112LI.Pc tsrf— (d) At least one accessible restroom for each sex or a single unisex restroom: $ --r, 000 (e) Accessible telephones: $ (f) Accessible drinking fountains:and, $ MA (g) When possible,additional accessible elements such as storage and alarms: $ KA TOTAL(shall equal line [2] of Valuation Computation): $ I(COO I:\Building\Permits\BUP-COM PermitApp.doc 03/03/2011