Permit (39) 4
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
i II Request for Permit Action r .
T I(_ A K l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigaard-or gt v' s
TO: 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: [Owner ❑ Applicant ❑ Contractor ❑ Ci S ff
Check(✓)one 0 1 D
REFUND OR Name:
,72y____
INVOICE TO: (Business or Individual) 1 A 1;1
j -fl (e j7 } g yO G i orle i ,-r ���/
Mailing Address: 15 350 SW 5Q Q.40101 tkw 9 - N°
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I
City/State/Zip: falx'-I'`411d, bik c)12'24
Phone No.: '/1b70'-' ( 2 _ 0O
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
[r REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: . U 2ot(0 - cSOL (oe
25 112. D C Oo�5 00 15845 7aA
Site Address or Parcel#: /1-De., (q
Project Name: C DY1 gO`t c A+G (A ' U r r[
Subdivision Name: Fah n cl 6 'e Ois ,tore Trotof Lot#:
EXPLANATION: ' , e• , . I I�• C r, if- • $VI. �• 9C.0•' • j//
Nev.) rrn i-I' p .14 f A 1 1 . s e kuL - l --oo oho ,�tY—'
Signature: LY7 M kfilX1 9 Date: J vl t 1 -7r Z( [ b
Print Name: ),..tSli G 0\4t,9
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended. fe 70
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service. o2 fl 0/ /9.2,I i 'vd
3. Please allow 3-4 weeks for processing refund re uests. „2",9,,,t — .:23,1'Y r 5 7,
` O ,:„.„+,, ,,,. ►tee c� -�t``� 1¢� n�I ,X19 ..�/5,X15 5.�.E$
1Q.e.1 we-t k:.---641°aot(2-00.0a9Z3
FOR OFFICE USE ONLY
Route to Sys Admin: Date 7 /6, _J9 Route to Records: Date`X,29/ , By 4 ,
Refund Processed: Date ' a/ to, By Invoice Processed: Date / By
Permit Canceled: Date 7/a., /f.+ By r arcel Tag Added: Date By
I:\Building\Forms\RegPernutAction_6923 4.doc
`' '1 .
TIGARD
City of Tigard
July 29,2016
Pacific Realty Associates LP
Attn: Leslie Louis
15350 SW Sequoia Pkwy, Suite 300
Portland, OR 97224
Re: Permit No. BUP2016-00168
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15895 SW 72nd Ave., Suite 195
Project Name: Consolidated Supply
Job No.: N/A
Refund Method: ® Check#221866 in the amount of$215.95.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$ .
Comment(s): Per applicant's request as revised scope of work was resubmitted under
BUP2016-00220. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Ac::C/5-2177776„fg-C___
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
1114
. " 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 Request for Permit Action 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: Pacific Realty Associates LP DATE: 7/21/2016
Attn: Leslie Louis
15350 SW Sequoia Pkwy, Ste 300 REQUESTED BY: Dianna Howse
Portland, OR 97224
TRANSACTION INFORMATION:
Receipt#: 403983 Case#: BUP2016-00168
Date: 5/18/2016 Address/Parcel: 15895 SW 72nd Ave, 195
Pay Method: CreditCard Project Name: Consolidated Supply
EXPLANATION: Per applicant's request as revised scope of work was resubmitted under BUP2016-
00220. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Iesnpnon From Receipt Revenue Aec+butlt°No. %R`.4fl
Example:;Building Permit Fee Example: 2300000-43104 $ dtuCtlt'
Building Permit Fee 230-0000-43104 $192.81
12%State Surcharge 100-0000-24001 23.14
TOTAL REFUND: $215.95
APPROVALS: SIGNATU /DATE:
If under$5,000 Professional Staff t00,-7WPI
_
If under$12,500 Division Manager
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: 7/,29 / By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD
BUILDING PERMIT
'1114 s. COMMUNITY DEVELOPMENT Permit#: BUP2016-00168
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2016
TIGARD 9 Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15895 SW 72ND AVE 195
Project: Consolidated Supply Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: Demising wall, rebuild suite entry,increase size of one office.
Contractor: PACIFIC REALTY ASSOCIATES LP Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY#300 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-624-6300 PHONE:
FAX: 503-624-7755
Specifics: FEES
Description Date Amount
Type of Use: COM DC Provision Review,COM TI-Ping 05/18/2016 $88.00
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Occupancy Load: 47 Permit Fee-Additions,Alterations, 05/18/2016 $241.01
Demolition
Dwelling Units: 0 12%State Surcharge-Building 05/18/2016 $28.92
Stories: 2 Height: 0 ft Plan Review 05/18/2016 $156.66
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 05/18/2016 $96.40
Value: $10,898 Info Process/Archiving-Lg$2.00(over 05/18/2016 $4.00
11x17)
Address Fee 05/18/2016 $50.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $664.99
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. 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(k Permittee Signature: `,/vu /&c kir1,1
Call 503.639.4175 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
CommercialFOR 01:121('E 11SF 011.1
C1 of TiAICd RECEIVE') Received
1g Date/B _ -0/w Permit No.: Q, —CO e
II
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review`� Other Permit:
_. Phone: 503.718.2439 Fax: 503.59MAi�0 1 8 2016 Date/B : d!k ®m
T I G n R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov O1{; T p�7 D Notified/Method: Supplemental Information
i i I 111V REQUIRED DATA:I-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 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
-:" CATEGORY OF CONSTRUCTION
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
'JOB--SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15895 SW 72"Ave. New dwelling area: square feet
City/State/ZIP:Portland,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:195 Project name:Consolidated Supply Covered porch area: square feet
Cross street/directions to job site:SW Upper Boones Ferry and 72"Ave. 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.
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.
Demising wall,rebuild suite entry,increase size of one office. Valuation: $$10,898.00
Existing building area: 4,627 square feet
New building area: 4,627 square feet
® PROPERTY OWNER ❑"TENANT Number of stories: 1
Name:PacTrust Type of construction: III-B
Address: 15350 SW Sequoia Parkway#300 Occupancy groups:
City/State/ZIP:Portland,OR 97224 Existing: B
Phone:(503)624-6300 Fax:(503)624-7755 New: B
1 APPLICANT ` ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:PacTrust (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Leslie Louis
FLS plan review fee(if applicable):
Address: 15350 SW Sequoia Parkway#300
City/State/ZIP:97224 Total fees due upon application:
Amount received:
Phone:(503)624-6300 Fax: :(503)624-7755
E-mail:lesliel@pactrust.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
• CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:PacTrust Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 15350 SW Sequoia Parkway#300 Solar Installation Specialty Code checklist.
City/State/ZIP:Portland,OR 97224 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)624-6300 Fax:(503)624-7755
State surcharge(12%of permit fee): $21.60
CCB lic.:153913
Total fee due upon application: $201.60
•
Authorized signature: t/6r111 L 4,4,4 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1e' 9 put✓ Date:INI1X1 `g Mtbt * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
INCOMMUNITY DEVELOPMENT DEPARTMENT
I
T I G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: L.-LP 0-0 14-CSD 1 (, g
Site Address: / S S-- <ck) -7 d Suite/Bldg#: /9S
Project Name:
C3)02/go//06-DI
(Name of commercial business occupying t��vacant,enter Spec Space.)
Planning Reviewr��
Proposal: / s yL(„9 7e 2
Existing Business Activity: C4C4(�l
Proposed Business Activity:
Verify site address/suite#exists and active in permit syst .
44/
°::ver Terrace Neighborhood: ❑ Yes No
I//Zoning: I -1)
tg yermitted Use: E' Yes ❑ No ❑ Spec Space
[ onfirm no land use required.
VJ Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
Notes:
)ieApproved by Planning: ..:.> 1 Date: s-//e
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: 5/ /(o
Site Plans: # ?l
Building Plans: # '77
Building Permit#: EF—Enter building permit#above.
Workflow Routing: Planning Building
Workflow Sign-off: Ca' 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: -------N
By Permit Technici n: A. _ I ,. p Date: 5 /2/0
I:\Building\Forms\BldgPermitRvw_COM_NolandUse 070915.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: El Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
1:\Building\Forms\B1dgPermitRvw_COM_NoLandUse_070915.docx