DDR2014-00004 VOIDED
DDR2O14 - 00004
Max ' s
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
= . " Request Permit Action
on
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD �
Building Division Services Supervisor n '
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov 4/15///
FROM: ❑ Owner El Applicant ❑ Contractor [►]amity Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) Pm,/g) tut ( HorpeA, C ,,, E147 i,411,1.,
Mailing Address: 1 211&O 5 w 6 •fi
City/State/Zip: ?i i &1 Fj re_ ?7L23
Phone No.: 5° 3 • 6 '17
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
.r CANCEL/VOID PERMIT APPLICATION.
Pr 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 #: Pb/2 Z 0/y" 00 C)o
Site Address or Parcel #: I )--s1,0i 7 (2-56 g Sw (/14 Aft' S r
Project Name: /. 4)( S
Subdivision Name: Lot #:
1
EXPLANATION: )r�'w►�i ✓�y,UV#IED e r o CJ`►c j/jCC�'t�
lout /1
(A-,/o /37.0.6.1.4.
/ c I u ,i✓o Kat es
(S L.041R4244,07st feent /0O To ,6z C qr y ,/0 z
Signature: 6-`g•-•-'7 tq e Date: 9` Z`f `Oa
Print Name: kiedt4S
1°L.
Refund Policy
1. l'he Community Development Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80°b of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 8(1%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80"4,of the building permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original paver in the form of a check. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date liv Rte to I ldmin: Date /o i3 /7 By 44-.
Refund Processed: Date/dA3//Y By Invoice Processed: Date By
Permit Canceled: Date /0/43/ir/ By d'�� Parcel Tag Added: Date By
Receipt# Date Method Amount$
1:A Building\I corms\Rey Permit ction_062614.doc
I' q
TIGARD
City of Tigard �')
October 13, 2014 l//
Hayden Consulting Engineers
Attn: David Miller -
12480 SW 68th Ave.
Tigard, OR 97223
Re: Permit No. DDR2014-00004
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12564& 12568 SW Main St.
Project Name: Max's
Job No.: N/A
Refund Method: ® Check#215185 in the amount of$651.00.
❑ Credit card "return" receipt in the amount of$
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): No review required per planner, Gary Pagenstecher. Refund 100% of
application fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
17.!
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 RequestforPermit 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: Hayden Consulting Engineers DATE: 10/2/2014
Attn: David Miller
12480 SW 68th Ave. REQUESTED BY: Dianna Howse
Tigard, OR 97223 GP
TRANSACTION INFORMATION:
Receipt#: 196580 Case #: DDR2014-00004
Date: 6/23/2014 Address/Parcel: 12564& 12568 SW Main St.
Pay Method: CreditCard Project Name: Max's
EXPLANATION: No review required per Gary Pagenstecher;refund 100% of application fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
DDR Compliance Letter(Type I) 100-0000-43116 $567.00
Long Range Planning Surcharge 100-0000-43117 84.00
TOTAL REFUND: $651.00
APPROVALS: SIGN TURES/DATE:
If under$5,000 Professional Staff
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: f03//y By: 421-7/
h\Building\Refunds\RefundRequcst.doc x 09/01/2010
V D
RE
1111 City of Tigard /o�/3/' ' JUN 2 3 2014
= Downtown Design Review
CITY ��'(J
TIGARDCom fiance Letter - Type I Applicac7'•- 1 ? a
GENERAL INFORMATION
Property Address/Location(s): 125&44i 103 p
KAPt`. 1 FOR STAFF USE ONLY
Tax Map&Tax Lot#(s): ZS CA 1 COQ 4@1770 / Case No.(s): DD f2 W4'0000y
ZiO2 C-c7 l to( 124(r1-in
Site Size: 0 2 •&,0A Other Case No.(s):
Applicant*: VAD(.004-4)VILA FLNAll i&,kj Fee: (.061-'
Address: L2t{ o') (Q iVI AVS Receipt No.: 1CICQSCSb
City/State:TIM M- D pCz Zip: e17ZZ 2 Date: (o(2 3 11`-k
Primary Contact:DPVID Application Accepted By. tc '
Phone: •61fg•I' Fax: 95.9403• 54414 Date Determined Complete:
E-Mail: DAd11 g I1J f� c7 Revised: 6/21/2)13
I:\CURPLN\Masten\Land Use Applications\Downtown Design Review-Type Ldoa
Property Owner/Deed er(s)*
(Attach list if o e th n tie)
Zk‘ �1( ((( REOUIRED SUBMITTAL ELEMENTS
"� Phone: (Applications will no/be accepted without the
Address:
City/State: Zip: following required submittal elements)
Q Application Form
Tr. . -: • ;- .a • • ' - a- Q Owner's Signature/Written Authorization
A Design Compliance Letter provides for a Type I review process, Q Title Transfer Instrument or Deed
using the clear and objective Design Standards. It is intended for 0 Site Plan(4 Large Plans&1 Reduced to 8 1/2" x 11")
smaller buildings and site renovation projects, which meet the Applicant's Statement/Narrative (4 copies)
threshold of 18.610.010.E.1. Filing Fee
Applicant's Statement/Narrative:
The applicant's statement must include a summary of the proposed
changes. Applicable criteria and design standards in 18.610 must be
addressed with a detailed response to each criterion. Failure to
provide the information needed to process the application would be
reason to consider an application incomplete and delay review of
the proposal.
In addition, the Director must find that the proposed change is in
compliance with all applicable requirements of Title 18 of the Tigard
Development Code. To complete this review, the Applicant's
proposal must include a discussion indicating how other
requirements of this title are still satisfied. These requirements
indude but are not limited to: access, landscaping and screening,
waste and recyclable storage, parking, sensitive lands, signs, tree
removal, vision clearance, and streets and utilities. Please see
section 18.610.035 of the Tigard Development Code for a complete
list.
City of Tigard I 13125 SW Hall Blvd.,Tigard,OR 97223 I 503-718-2421 I www.tigard-or.gov Page 1 of 2
*When the owner and the applicant are different people, the applicant must be the purchaser of record or a lessee in
possession with written authorization from the owner or an agent of the owner. The owner(s)must sign this application
in the space provided on the back of this form or submit a written authorization with this application.
Responsibility Statement As the applicant submitting this application for a land use review, I certify that all of the above
statements and the statements in the site plan,attachments,and exhibits transmitted herewith,are true;and I acknowledge that any
permit issued,based on this application may be revoked if it is found that any such statements are false. I am also responsible for
gaining the permission of the owner(s) of the property listed above in order to apply for this review and for reviewing the
responsibility statement with them. If the application is granted,the applicant will exercise the rights granted in accordance with
the terms and subject to all the conditions and limitations of the approval. The above request does not violate any deed restrictions
that may be attached to or imposed upon the subject property. The applicant has read the entire contents of the application,
including the policies and criteria,and understands the requirements for approving or denying the application. The City of Tigard
is not liable if any of these actions are taken without the consent of the owner(s) of the property. In order to process this review,
City staff may visit the site,photograph the property,or otherwise document the site as part of the review. By my signature, I
indicate my understanding and agreement to the Responsibility Statement.
SIGNATURES of each owner of the subject property.
DA1L1)this 2j" day of J UA.)G ,20 14
<7E-4- LA-
Applicant/Authorized Agent's Signature Owner's Signature
Owner's Signature Owner's Signature
u.<r wR:a#aW:52'.9m.'tm6�'c:.,. Y.kYv.^..�)A.:..:�H: a...a^.J.Lawh 3T.s`t.s .::» ...,rA...Snin£r..l..k.•.....YZK:YSai.�'mt�OWS:...BGYit-dAa.S.At�T.:FSi.�4fC�X12,
City of Tigard ( 13125 Ste'Hall Blvd.,Tigard,OR 97223 I 503-6394171 j www.tigard-or.gov j Page 2 of 2
We certifiy thi Instrument to be a u ,
AFTER RECORDING RETURN TO:
12562 Main Street,LLC Copy of �L as 2.L.)17---t� �
C/O George Diamond Records I' (,"
2839 SW 2nd Avenue Records of l U 11--; 1-4---t I7 11
Portland,OR 97201
CHICAGO TITLE COM NY
SEND TAX STATEMENTS TO: By J�
Same as above
Escrow No: 472512498568CE-CT50
SPACE ABOVE THIS LINE FOR RECORDER'S USE
WARRANTY DEED—STATUTORY FORM
(INDIVIDUAL or CORPORATION)
1.1
Two G's Real Estate,LLC,an Oregon limited liability company
Grantor,conveys and warrants to
41.0 12562 Main Street LLC,an Oregon limited liability company
Grantee,the following described real property free of encumbrances except as specifically set
psi forth herein:SEE EXHIBIT"A" LEGAL DESCRIPTION ATTACHED HERETO
The true consideration for this conveyance is$1,070,000.00.
gENCUMBRANCES: SEE ATTACHED EXHIBIT"B"
BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT,THE PERSON TRANSFERRING FEE TITLE
V SHOULD INQUIRE ABOUT THE PERSON'S RIGHTS,IF ANY,UNDER ORS 195.300,195.301 AND
195.305 TO 195.336 AND SECTIONS 5 TO 11,CHAPTER 424,OREGON LAWS 2007,SECTIONS 2
TO 9 AND 17,CHAPTER 855,OREGON LAWS 2009,AND SECTIONS 2 TO 7,CHAPTER 8,
OREGON LAWS 2010.THIS INSTRUMENT DOES NOT ALLOW USE OF THE PROPERTY
DESCRIBED IN THIS INSTRUMENT IN VIOLATION OF APPLICABLE LAND USE LAWS AND
REGULATIONS.BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT,THE PERSON
ACQUIRING FEE TITLE TO THE PROPERTY SHOULD CHECK WITH THE APPROPRIATE CITY OR
COUNTY PLANNING DEPARTMENT TO VERIFY THAT THE UNIT OF LAND BEING TRANSFERRED
ISA LAWFULLY ESTABLISHED LOT OR PARCEL,AS DEFINED IN ORS 92.010 OR 215.010,TO
VERIFY THE APPROVED USES OF THE LOT OR PARCEL,TO DETERMINE ANY LIMITS ON
LAWSUITS AGAINST FARMING OR FOREST PRACTICES,AS DEFINED IN ORS 30.930,AND TO
INQUIRE ABOUT THE RIGHTS OF NEIGHBORING PROPERTY OWNERS,IF ANY,UNDER ORS
195.300,195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11,CHAPTER 424,OREGON
LAWS 2007,SECTIONS 2 TO 9 AND 17,CHAPTER 855,OREGON LAWS 2009,AND SECTIONS 2
TO 7,CHAPTER 8,OREGON LAWS 2010.
Dated:June 25,2012;if a corporate grantor,it has caused its name to be signed by order of its board
of directors.
Two G's Real Estate,LLC,an Oregon limited
liability company
By:Two G's Ven C,an • • limited
liability comp- -
By. r
c/:..rd,Manager
STATE OF OREGON
��
County of M U_ fI4 t$ j —
Thls instrument was acknowledged before me this June 2-5 ,2012,by Russell G.Goddard,Manager
of Two G's Ventures,LLC,an Oregon limited liability company,Sole Member of Two G's Real Estate,
LLC,an Oregon limited liability company.
ZO/nThOFFICIAL SEAL
No lic for Oregon CHERYLE BEA STAHEL-EASTMAN
Ty g !S f t� ✓); NOTARY PUBLIC-OREGON
My Commission Expires: �1 / �,�, COMMISSION NO.457381
MY COMMISSION EXPIRES MAY 15,2015
472512498588CE-CT50
Deed(Warranty—Statutory(Individual or Corporation))
, o7� oEl
12480 SW 681h Ave.
Consulting engineers Tigard, Oregon 97223
Phone: 503-968-9994
5tructuraL Lngineering Fax: 503-968-8444
June 23, 2014
City of Tigard
Re: New opening between adjacent buildings & New garage doors
Type I Application
12564 & 12568 SW Main St.
Tigard, OR 97223
HCE Project #14065
Tax Map & Tax Lot # 2S 102AC01 100 & 2S 102AC 1 101
Narrative Per Downtown Plan District 18.610(Track 1)
The purpose of the project at 12564 & 12568 SW Main Street is to create interior access
between upper floors and new garage door located at the back of the 12564 building
for the current tenant in 12564 SW Main Street.
i. Addition, elimination, or change in location of windows that does not decrease the
minimum required window coverage.
No modifications.
ii. Addition, elimination, or change in location of entry doors and loading doors.
One additional overhead garage door will be added to the (East Side) back of
the building for equipment storage.
iii. Addition of new and change to existing awnings, canopies, and other mounted structures
to an existing façade.
No changes or new structures are to be added to existing buildings.
iv. For commercial and mixed use developments, modification of up lo 15%on—site
landscaping with no reduction in required landscaping. Modification refers to changing
the hardscape elements and the location of required landscape areas and/or trees.
No modifications.
v. Modification of off-street parking with no reduction in required parking spaces or
increase in paved area.
No modifications.
Hayden Consulting Engineers, Inc.
Page 2 12564 & 12568 SW Main Street 6/23/2014
vi. Addition of new fences, retaining walls, or both.
No modifications.
vii. Changing of existing grade.
No modifications.
viii. An increase in the height of the building(s) less than 20%.
No modifications.
ix. A change in the type and location of access ways and parking areas where off-site
traffic would not be affected
New garage door will not affect traffic access or parking.
x. An increase in the floor area proposed for a nonresidential use by less than 10%or
under 5,000 square feet.
The access bridge between floors will only add approximately 50 sq. ft.
xi. A reduction in the area reserved for common open space and/or usable open space which
does not reduce the open space area below the minimum required by this code or reduces
the open space area by less than 10%.
No modifications.
Sincerely,
Hayden Consulting Engineers, Inc.
OF
4„...
By:_ 1',
Hayden Consulting Engineers, Inc.
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1, SITE PLAN
N.T.S.
I'll , ; ; ��A vd o E1 ' NEW OPENING BETWEEN BUILDINGS BY DLM DATE 06.23.2014
Consulting Engineers REV BY DATE
6T2uCTu12A,L LNGINEEIZINc 12568 SW MAIN STREET JOB NO 14065
12480on :(S68t9.Ave.,4Tigard,Oregon -844 TIGARD, OREGON SHEET 1 OF
Phone:(503)968-9994/Fox:(503)968-8444
W W W.HAYDEN-ENGINEERS.COM