Permit Support Document (8) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN1 , ("")
s
Re quest for Permit Action •
q 76/i7 ,
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
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 ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) (Ai/I/6'47 q((-Vetie4
Mailing Address: /2 7 ,1 Sc-j /e( ,/
City/State/Zip: 1 easier" (Jf ?667 5
.� `—'
Phone No.: CO -- 3() ? yZ6l,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
►1 CANCEL/ OID PERMIT APPLICATION.
❑ REF ► i ERMIT 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#: a'1",2d,/ 7`,!plc)?3
Site Address or Parcel#: SJ V ,
Project Name:
. fig
Subdivision Name: Lot#:
EXPLANATION:
fk)Lt/2 /f C e, ;/fie' /71
S /3•u/".4/7 -dl1/r te
Ark� k j
F / / Date: V 7-
Print Name: / .M Veil e(/
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date Z 7 /7 By 4° Route to Records: Date 2 6 /7 By 11,:,
Refund Processed: Date /, By (41f Invoice Processed: Date $
Permit Canceled: Date -2 "/7? By 040', Parcel Tag Added: Date By
\Building\Forms\RegPemutAction_092314.doc y
Building Permit Application /� i 7qV 0 1 D
Commercial
FOR OHI ICI. l SI: ONL1
jihiCity of Tigard Received ..a
13125Ill SW Hall Blvd.,Tigard,OR 97223'-+';: ` Date/B : PermitNo.:
C ,p� 1I 1
Phone: 503-718-2439 Fax: 503-598-1960
Plan Review
Q,i 'i.
Ins ection Line: 503-639-4175 Date/B : Related Permit:/fir ?7 G/f
T 1 G A R D p 4 Date Read/B _Pi
Internet: www.tigard-or.gov Ready/By: J""s. See Page 2 for
Notified Method: Supplemental Information
TYPE OF Vo�'�.,,a"`t. E;,F �;i R .
a. ,�,..,. ,. a.':- '''''-)1 rod 1
REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
,
ddition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 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: 6'4?2,,1
JS ) d/1 f` 6/ tQ New dwelling area: square feet
City/State/ZIP: -7; �
tic, . Garage/carport area: square feet
Suite/bldg./apt.#: I Project name: ✓-T-
t / t/4( 466, Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: REQUIRED DATA:COMMERCIAL-USE CHECKLIST
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
DESCRIPTION OF WORK equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
tl34115-
4/0
5- (�- 9 rett)4../ Valuation: $ 7
�,2Existing building area:t . /`square feet
New building area: J square feetJ� } (‘
0 PROPERTY OWNER I 0 TENANTNumb
er of stories:
Name:
Address:
Type of construction:
City/State/ZIP: Occupancy groups:
Existing:
Phone:( )
Fax:( )
❑ APPLICANT New:
0 CONTACT PERSON BUILDING PERMIT FEES*
Business name:
(Please refer to fee schedule)
Contact name: Structural plan review fee(or deposit):
Address: FLS plan review fee(if applicable):
City/State/ZIP: Total fees due upon application: ;did,�r
Phone:( ) I Fax::
��� � / ( ) Amount received:
E-mail: Y�l✓ ;(7,COl tied PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTORCommercial and residential prescriptive installation of
Business name: 6001 / r ' / ` roof-top mounted Photo Voltaic Solar Panel System.
/ham V9lte't/J 144. e y(
L G �r?✓1 ^��6✓L►� Submit two(2)sets of roof plan with connection details
Address: 7 j^�- t j p`./A ore, and fire department acce along with the 2010 Oregon
i� r �J'r f Solar Installation Specially Code checklist.
City/State/ZIP: eez. ,a r 4/4
d2 - Permit fee(includes plan review
Phone:(.93) ) YZ C)J p I Fax:( )
.77(49 ` and administrative fees): $180.00
CCB Lic.: / 3���/��' State surcharge(12%of permit fee): $21.60
Authorized signature:
T Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
v within 180 days after it has been accepted as complete.
I Print name:
At . `/tie)
/e4 a
e `C I Date: 3 2?-/9 I * Fee methodology set by Tri-County Building Industry
/ ( Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014
440-4613T(11/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
" Accessibility: Barrier Removal Improvement Plan
"� _ ulti-Famil - Additions or Alterations
Commercial & M y
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, [1] $
excluding painting and wallpapering:
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): $
\Building\Permits\BUP_COM_PermitApp•doc Rev.12/18/2014
City of Tigard
111 COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A It D Building Permit Review — Commercial - With Land Use
Building Permit #: dZ` ij>7_000 )3
Site Address: 67e,a' aL) oak 4 Suite/Bldg#:
Project Name: 4 b .
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: AM.0 /22r7lih'Ort kzA7
Verify site address/suite#exists and active inste ermit s
P Y
Ili ° ver Terrace Neighborhood: ❑ Yes V No
V/ Land Use Case#: /i , Q oite— epi) )`mac)/le- ZOO
l�J Pl s Match Approved Land Use: J
V01, 'Site Plan OLandscape Plan V Other: 7Joi
0lI1rban Forestry Plan tUlevation Plan
t I uilding Height: Maximum Height Actual Height �X� �
ht
❑ onditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
96 Business Lice e:
Exists: Yes ❑ No,applicant notified to obtain business license
OPOublic Facilities Improvement(PFI) Permit:
Required: ❑��fYj/es,applicant was no • ied No App *ed For: El Yes ❑ No,stop intake
�--�'
Notes: ,4616 s Lsk//� j /'I0>'- C'CL/ C>l
Approved byPlanning: — .
PP ,, .1' Date: cS7/279-// –
Revisions
/27 //—
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�1 11 7
Site Plans: # `
Building Plans: ## 4r-
Building Permit#: ❑ Enter building permit above. ..
Workflow Routing: fining ngineering t Coordinator E f uildtn
Workflow Si off: g
�- 8"Si�,.off for Planning(include notes from planning review)
Route Application Documents: It "Building: original permit application,site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician:
- Date: 3/,l/i )
I:\Building\Forms\B1dgPermitRvw COM_WithlandUse 060116.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
e......„„oP
Approved by Engineering: Date: ., --,./927
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
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:
DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes /A
Tigard Trans SDC: ❑ Yes no /A
Parks SDC: CI Yes L'•N/A
OK to Issue Permit
Approved by Permit Coordinator: Date: 3
I:\Building\Forms\B1dgPermitRvw_COM_WithLandUse_070915.docx