Permit CITY OF TIGARD BUILDING PERMIT
2 . ' COMMUNITY DEVELOPMENT Permit#: BUP2016-00239
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 08/31/2016
TB1MT,T 9
Parcel: 2S102DB00100
Jurisdiction: Tigard
Site address: 8840 SW BURNHAM ST
Project: Frontier Subdivision: None Lot: None
Project Description: Adding 4 walls to create 3 offices,removing portion of 1 wall.
Contractor: SPECIALTY SERVICES Owner: FRONTIER COMMUNICATIONS NORTHWES
PO BOX 1311 PO BOX 152206
CLACKAMAS, OR 97015 IRVING,TX 75015
PHONE: 503-307-2890 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 08/31/2016 $520.07
Demolition
Occupancy Grp: B Occupancy Load: 29 12%State Surcharge-Building 08/31/2016 $62.41
Dwelling Units: 0 Plan Review 08/02/2016 $338.05
Stories: 1 Height: 0 ft Plan Review-Fire Life Safety 08/31/2016 $208.03
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Sm$0.50(up to 08/31/2016 $1.00
Value: $31,000 11x17)
DC Provision Review,COM TI-Ping 08/31/2016 $90.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,219.56
Required: Required Items and Reports(Conditions)
Fire Sprinkler: 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 cop of the rules or direct questions to OUNC by calling 51• 32.1•:7 or 1.800.332.2344.
Issued By: Per ,_ ',nature: v i•
tiefrig
Ate' :'" .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 e project.
Approved plans are required on the job site at the time of each inspection.
A
Building Permit Application
Commercial RECEIVE[ FOR 01.H(. I:SE 051.1
Cl Tigard Tl and Received Z/Y/w Permit No.: 4_ ',PO/6-60,23r
Date/By: (34
' 13125 SW Hall Blvd.,Tigard,OR 9722.H' 2 2016
�tjj Qa Plan Review
Phone: 503-718-2439 Fax: 503-598- Date/By: / Related Permit
(
� �[
T I G A FZ D Inspection Line: 503-639-4175
CITY Date Ready /�` it Juris: I H See Page 2 for
Internet: www.tigard-or.gov OF TIGARD 'fled/Me hod: Supplemental Information
BUILDING DIVISION
TYPE OF WORK to( ��
REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 51 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.
Valuation: $
❑1-and 2-family dwelling `Commercial/industrial
1:1Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 1:1Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: )
�',O�'"cl(..? � bLr r\I,.‘(.,.,,,..\ (_c i New dwelling area: square feet
City/State/ZIP: '�` Garage/carport area: square feet
Suite/bldg./apt.#: Project name: �' , a Coveredporch area:
fir;{"�'t r: I tca'�:'-C;� square feet
Cross street/directions to job site: tt ,� Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 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.
Valuation: $ �s�t
(?)1_..t.1.
Ic S roc, —1 l_."\C- S -1-z.--, tAt .VS C. l'_'_'1 t('c'.,S _ __ C. _
�� Existing building area: square feet caJ (r ",
Ccat�z� �����, New building area: square feet SC`C,
ROPERTY OWNER 0 TENANT Number of stories: ( I
Name:
e(1Y1 r i S')'r Gw>.se,i",% Type of construction: I'n t-k - tE,, U-,,(,' e�
��
Address: j i -� 54,,,t-+ 5 G.t•1' t' - I c ., Occupancy groups: t
City/State/ZIP:. ,1,,l- * ` A I As.�"�G,j Existing:
Phone:(1{c)5) at- ..V l a Fax:( ,` e'" �c
New.
,APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: . (Please refer to fee schedule)
�x C iG. l '� 'C.. _.
Contact name: '� Structural plan review fee(or deposit):
itiY1
J FLS plan review fee(if applicable):
Address:
p c., il...„,..,,, Total fees due u on application:
City/State/ZIP: <L.\u C.rcve...� � G')CG). p pp
Phone:(rte-5)-?C.�� _ ;-).` 4.-1C)PJ J Fax::( ) Amount received3�g !sS
E-mail:j"° PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
i rY� I).cc c. •Sc-r V i G..t✓�
Commercial and residential prescriptive installation of
CONTRACTOR f-top mounted PhotoVoltaic Solar Pane em.
Business name: I....1- Submit sets of roof plan wi • inflection details
_Trig- I c-' i S c r'v , C'e and fireccess,a s g with the 2010 Oregon
Address: 9G
I 1 _ Solar Installation Specil'°: ode checklist.
City/State/ZIP: ((�� <"'' Permit fee = eludes la' view
ty C�Gc15eA(t�� C� �" j �C>1 .nd administrative fe $180.00
i
Phone:(5c.:1-,>) __ ct C_)/ Fax ( ) S -surcharge(12%of permit fee): $21.60
CCB Lic.: l '-'i 4 e. Li ,f
Authorized signature:)(17Total fee due upon application: $201.60
rear" This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: l rn ' i/
� Date: _ ' * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
114 Accessibility: Barrier Removal Improvement Plan
C
Commercial & Multi-Family - Additions or Alterations
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
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 percent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
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 $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $
P-4
ASI ) A c e5S ,L C
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.12/18/2014
s
City of Tigard
IN " COMMUNITY DEVELOPMENT DEPARTMENT
I
T I G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: 6 t,tIJt 11,-Gv 3
Site Address: 002710 ,,Ser0 -DI,.0.ffi cS3 Suite/Bldg#:
Project Name: Yr A:71--
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: .f -C-"59. 7!...... 7�zzon
Existing Business Activity: o �!jPro osed Business Activity: //
Verify site address/suite# exists and active in permit sys m.
ti ''I ver Terrace Neighborhood: ❑ Yes No
oning: _ =m
/ermitted Use: rieYes ❑ No ❑ P
Spec Space
11" Confirm no land use required.
�(/Business License
Exists: pCJ Yes ❑ No,applicant notified to obtain business license
Notes:
J s
Approved
PP by Planning: _. .iii�.A Date: 0(-
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 8 a / i
Site Plans: ## r 4
Building Plans: #
Building Permit#: Er-Enter building permit#above. ��
Workflow Routing: a-Planning hermit Coordinator E Building
Workflow Sign-off: Q.-Sign-off for Planning(include notes from planning review)
Route Application Documents: 0 Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: C _ , I_ _, __ Date: Vol-bP
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_060116.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:
?56DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes N/A
K to Issue Permit
c
Approved by
Permit Coordinator: Date: 2/
2C/ /4°
1:\Building\Forms\BldgPermitRvw_COM NoLandUse 070915.docx
ill �� City ofT ° .rl.c>mmt.:Nnx t>EVE1,OP ME NT DEP ARTmN T -I
Request for Permit Action /,,,,,/,,,/%k , ,.:
13125 SW Hall Blvd. Tigard, Oregon 97223 503-718,-2439
TO: CITY OF TIAI
Building Division
13125 SW f fall Blvd.,Tigard,OR 97223
Phone; 503-718-2439 Fa:: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: I Owner 0 Applicant yr contractor city Staff
check(1t one
REFUND OR Name:
INVOICE 'o: (Business or Individual) Cf
Mailing Address: a `--"' `_,
cite'/State/zip: . .gyp ..c , 0-
. ,
Phone No.: - (7,7S-- -
PLEASE TA KE ACTION FOR THE ITE (S) CHECKED•KED (1):
I ICANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR F1-?ES DUE (attach case fee schedule and provide explanation below).
0 REM( )VE/REPLACE CON'f :.ACTOR ON PERMIT (do not cancel permit).
Permit t : 7 u -' e02---Sef --
Site Address or Parcel#: L 21-0 0e 1CC1s
Project Name: i"t.,C :k.4.c...„(
Subdivision Name: ../(t)./0. ' Lot#:
Signature: —_..
Print Name: Date: ( - t -
Refund Policy
t. The city's Community Development Director,Building 0ffieitel or(a:y I gineer may amhor•ixe the refund o3:
0 Any fee which was erroneously paid or coliccted.
• Not more than 80IVe of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 8M7,of the application o£,permit the t<r issued permits poor to am inspection requests.
2. rP1 refunds will he returned to the original payer-in the form of a check ata I.IS postal service.
3, Please allow:3-4 weeks for processing refund requests.
_...56 =Y I' 763- . 9 9 //6 , f`Y
a
�.,�.. ua. au.'' �� `�.`.m,:�...� Fl.:. ,;E,ttl �a�: ..a a'� ":�.,-�s - ��h ' ��.<-���\�� \\ r�r fi�, 1:
\-� � �s. .=�t`� syr '��..r�y� 'c� ����.���.Z`` .
Route to Sys�udmin. Dare
l By Route in Records: Dare j �"/ A
Refund Processed: Datejet ,, //,,c, 'i
Bu .i/,, Invoice Pocessed: Date � y
By
Permit Canceled: Dare
,A52//.2./t. l By 0 r j Parcel Tag Added: Date By
I:rBuiktiue\,i ornrs7,RugPermitlet,on_1 4,c or
Ill
TIGARD
December 15, 2016 City of Tigard
Specialty Services
PO Box 1311
Clackamas, OR 97015
Re: Permit No. BUP2016-00239
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 8840 SW Burnham St
Project Name: Frontier
Job No.: N/A
Refund Method: ® Check#223297 in the amount of$465.99.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit"receipt in the amount of$ .
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerel ,
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
Tl GARD 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 forPermit 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: Specialty Services DATE:
PO Box 1311 12/12/2016
Clackamas, OR 97015 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 405937
Case#: BUP2016-00239
Date: 8/31/2016 Address/Parcel: 8840 SW Burnham St.
Pay Method: Check Project Name: Frontier
EXPLANATION: Per applicant's request as the job was cancelled. Refund 80%of permit fees.
Fee Deserip{ion From Receipt c =
nrxe�Jthu>� . eti;
Example: B, g c
Buil p °Permit.Fee; E: p1e; 2$00000 43i "
�'g Permit 230-0000-43104
12%State Surcharge $416.06
100-0000-24001 49.9393
TOTAL REFUND: $465.99
APPROVALS: SIGNATURES/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: I /6//7 I By: I
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
114 CITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
/e�� ,
Receipt Number: 408248 - 01/06/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2016-00239 •u/° /0672,y/T" v .3o-0000—y3/0 9 yi6 'Da. > $-465.99
/2„470 ri-e6#9726-e— K6 D -6000 —o2.yooi x'9,93
Total: 8-465.99
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 223297 DHOWSE 01/06/2017 $-465.99
Payor: Specialty Services
Total Payments: $-465.99
Balance Due: $465.99
Page 1 of 1
flifCq
ITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
D//.f 6 i Je _-
I Receipt Number: 405937 - 08/31/2016
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2016-00239 Permit Fee-Additions,Alterations, 230-0000-43104 $520.07 E--
Demolition
BUP2016-00239 12%State Surcharge-Building 100-0000-24001 $62.41 rc—
BUP2016-00239 Plan Review-Fire Life Safety 230-0000-43108 $208.03
BUP2016-00239 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $1.00
11x17)
BUP2016-00239 DC Provision Review, COM TI-Ping 100-0000-43112 $90.00
Total: $881.51
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 715318 BTAGGART 08/31/2016 $881.51
Payor: Specialty Services, LLC
Total Payments: $881.51
Balance Due: $0.00
Page 1 of 1