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Permit Support Document (164) H G T. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 7 2016 le I Request for Permit Actiong '! . TI G A RD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov I.,...A TO: CITY OF TIGARD OID Building Division V 13125 SW Hall Blvd.,Tigard,OR 97223 7j,27//(� Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-o .gov Com- 7 FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Gray Construction Mailing Address: 5410 SW Macadam Ave. City/State/Zip: Portland, OR 97239 Phone No.: 503 228-4729 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑x 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). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: FPS2016-00104 9624 Washington Square RD Site Address or Parcel#: Portland, OR 97223 Project Name: Amazon Books Subdivision Name: Lot#: EXPLANATION: Signature: Mark MckeeV / Date: 7/27/2016 Print Name: Mark McKeever 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. Route to Sys Admin: _ Date By Route to Records: Date /L? /A By Refund Processed: Date 4//9- By<ezy Invoice Processed: Date / By Permit Canceled: Date 7 .2:7//k,. ByAttV Parcel Tag Added: Date By I:\Building\Forms\RcgPermitAction_ 9231eddoc Building Permit Application Fire Protection System `` �, ; 1 ',+ ,. FOR OFFICE USE ONLY �;_' ' Cityof Tigard Received g Date/B : 6 Permit No.: 14 13125 SW Hall Blvd.,Tigard,OR 97223 Y 1iI .�/L'A i :� _ A ';0\b Plan Review �(f ' 11 Phone: 503.718.2439 Fax: 503.598.1960 !^N , '..k)'' Date/By: Other Permit: y� II G A R D Inspection Line: 503.639.4175 spate Ready/By: Juris: h7 See Page 2 for �" Internet: www.tigard-or.gov 2, -Notified/Method: .�,G Supplemental Information 1 . + • 1X ii k: ./:TYPE OF WO m t i .' = REQUIRED ?ATA I-AND 2-FAMILY DWELLING, El New construction R 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 El Other: equipment,materials,labor,overhead,and the profit for the P ,, CATEGORY of NS`.RUCT.iON ,,, work indicated on this application. El1-and 2-family dwelling Commercial/industrial Valuation: $ ElAccessory building ElMulti-familyNumber of bedrooms: El Master builder El Other: Number of bathrooms: t%n:-.. JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 962(1i k/ 4 i _ New dwelling area: square feet City/State/ZIP: y/ „ ... 7/, Garage/carport area: square feet Suite/bldg./apt.no.:/ Project name: X,vve} ,_, /.O/S Covered porch area: square feet Cross street/directionsellto job site: Deck area: square feet .7 ��"”" � �' �i// -v f7 ti ,/e,-..--/--4-- Other structure area: square feet Sim = REQUIRER DATA:COMMERCIAL4JSE 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. ICl/•1 (/reit/ yi 7%IJ!/t Ze3'- S M ,`✓ reIC.ta,, ,,e41,/' Valuation: $ © CJ / / 6� - / Existing building area: 7 y�0 square feet Ii(e � New building area: square feet ❑;,PROPERTY OWNER IT.'. . .. ., ,TENANT X; - ;, Number of stories: 1 Name: M ft g✓ Type of construction: Address: o/2 Z ,� /© x Occupancy groups: City/State/ZIP: .,,,,44`,/ 44 9 ic%0 Existing: Phone:( ) Fax:( ) �, ,:_• New: 0 APPLI 'ANT: 0 CONTACT PERSON Business name: "'/-� // NOTICE C� /�� / '^ 2 All contractors and subcontractors are required to be Contact name:/f/2 k 446 k C-c vt=� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1-121 t f, i, /44-3.- jurisdiction in which work is being performed.If the City/State/ZIP: /I / 2 re) S applicant is exempt from licensing,the following reasons ,7 ryhit, i apply: Phone:( 7/Y) LI/2 3 S 16 Fax: :( ) E-mail: in M G ,/ F c-L- 2 5(4-it. - Go/V1. , iCONTRACT9R ",. ... ' )<#1JILI'INGPlt+<RMIT FEES*'n . Business name: ,'. --.0,,,---_ .<___ ",... . -,. Pease refer ..feeese due) , Address: (42 i F /'✓ Cc> cs-� ; svPermit fee: State surcharge(12%of permit fee): City/State/ZIP: /J,+V,'/-11']z*,,� aI 4 4/ 2_g-0 s �f ) / FLS plan review(40%of permit fee): Phone:( it 2 —3 rj f. Fax:( ) (Due upon application submittal.) CCB lic.: l Li 2. 33 67 Total permit fees: Authorized signature Amount received: This permit application expires if a permit is not obtained Print name: J+4[ 5 1d. within 180 days after it has been accepted as complete. CS`3 /p 1 �d /j> Date: �`• , * Fee methodology set by Tri-County Building Industry i'"..7/11) tl i./h — - Service Board. 1:,BuildingvPermits\FPS-Pert,pp_0310 .doc 440-4613'J(11i02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information , -Describe:work to be done: 1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices: ❑ New system Number of sprinkler heads: 27 Number of alarm devices: ❑ Addition or ❑ 1-10 heads: Affidavit required and El 1-5 devices: Affidavit required and Alteration (3) copies of sketch showing area (3) copies of sketch showing area to existing of wo ithin building structure of work within building structure system 11+ heads: Plan review required and El 6+ devices: Plan review required and (3) sets of plans. (3) sets of plans. Additional description of work: Type of System (Complete A,B,C or D as applicable); A.) Commercial Sprinkler Sprinkler Type ❑ Wet El Dry Additional Standpipes Information: Sprinkler Supply Line ❑ Yes El No Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire SuSuppression Syste .tt Hood Project Valuation: $ Submittal shall Battery Calculations ElYes include: Individual Component ElYes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkle,r(Stand Alone System) rx Square Footage: Permit Fee: 0 to 2,000 $198.75 k „� 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fe P apt, etio Pex. F . Project valuation subtotal (see A,B&C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review(40% of permit fee): $ TOTAL: $ T:ABuilding\Permits\FPS_Permit,lpp_031016.doc 2