Permit (102) C
TIGARD
City of Tigard
August 9, 2019
Trinity Community Church
10900 SW 121"Ave
Tigard, OR 97223
Re:Permit No. BUP2019-00104
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 10900 SW 121"Ave
Project Name: Trinity Community Church
Job No.: N/A
Refund: ® Check#232957 in the amount of$3,666.83.
❑ Credit card "return" receipt in the amount of$
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$
Comments: Scope of work and project valuation changed from$325,000 to $80,000
resulting in a reduction of permit fees. Refund the difference.
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
111
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: Trinity Community Church DATE: 8/2/2019
10900 SW 121st Ave
Tigard, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 422983&423283 Case#: BUP2019-00104
Date: 4/22/2019&5/6/2019 Address/Parcel: 10900 SW 121st Ave
Pay Method: Check Project Name: Trinity Community Church
EXPLANATION: Scope of work and project valuation reduced from$325,000 to$80,000 resulting in a
reduction of permit fees. Refund 100% of difference.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Cash over 100-0000-48001 $3,666.83
TOTAL REFUND: $3,666.83
APPROVALS: SIGNAT RES/D TE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: d-'/?-T7 -/ By: 4( )
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
q
CITY OF TIGARD RECEIPT
1 ` • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TUG AR.D
Project Name: Trinity Community Church
Site Address: 10900 SW 121ST AVE
[N n
Receipt Number: 436092 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
B U P2019-00104 $-891.24
Total: $-891.24
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232957 DHOWSE 08/27/2021 $-891.24
Payer: Trinity Community Church
Total Payments: $-891.24
Balance Due: $891.24
Page 1 of 1
III CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGAR 0
Project Name: Trinity Community Church
Site Address: 10900 SW 121 ST AVE
0/2-f Ei Aif/Z_
Receipt Number: 422983 - 04/22/2019 I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00104 Plan Review 230-0000-43106 $620.98
BUP2019-00104 Additional Plan Review 230-0000-43106 $90.00
BUP2019-00104 Cash Over 100-0000-48001 $891.24 e
Total: $1,602.22
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1140 STOLES 04/22/2019 $1,602.22
Payor: Trinity Community Church
Total Payments: $1,602.22
Balance Due: $0.00
Page 1 of 1
1111 CITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Trinity Community Church
Site Address: 10900 SW 121ST AVE / -A1Z
Receipt Number: 436093 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00104 $-2,775.59
Total: $-2,775.59
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232957 DHOWSE 08/27/2021 $-2,775.59
Payor: Trinity Community Church
Total Payments: $-2,775.59
Balance Due: $3,666.83
Page 1 of 1
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IIIICITY OF TIGARD RECEIPT
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TfGA.I D
Project Name: Trinity Community Church
Site Address: 10900 SW 121ST AVE
d7Z/Gi/\ '1'v
IReceipt Number: 423283 - 05/06/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00104 DC Provision Review, COM TI-Ping 1 00-0000-431 1 2 $254.00
BUP2019-00104 Permit Fee-Additions,Alterations, 230-0000-43104 $955.35
Demolition
BUP2019-00104 12% State Surcharge-Building 100-0000-24001 $114.64
BUP2019-00104 Plan Review-Fire Life Safety 230-0000-43108 $382.14
BUP2019-00104 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $36.00
11x17)
BUP2019-00104 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $61.50
11x17)
BUP2019-00104 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $32.00
11x17)
BUP2019-00104 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $11.00
11x17)
BUP2019-00104 Cash Over 100-0000-48001 $2,775.594.
Total: $4,622.22
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1154 BTAGGART 05/06/2019 $4,622.22
Payor: Trinity Community Church
Total Payments: $4,622.22
Balance Due: $0.00
i
i
i
Page 1 of 1
CITY OF TIGARD FEE AND PAYMENT HISTORY
III
I s 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
BUP2019-00104 - 10900 SW 121ST AVE, TIGARD, OR 97223 a
Trinity Community Church =
i
Revenue Payment
i
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
12% State Surcharge- Building 100-0000-24001 $114.64 $114.64 $114.64 7/31/2019 Check 423283 $0.00 x
Additional Plan Review 230-0000-43106 $90.00 $90.00 $90.00 7/31/2019 Check 422983 $0.00
Cash Over ,Z 7 .Ai 1j 100-0000-48001 $3,666.83 $3,666.83 $891.24 7/31/2019 Check 422983 $0.00
' $2,775.59 7/31/2019 Check 423283
DC Provision Review, COM TI-Ping 1 00-0000-431 1 2 $254.00 $254.00 $254.00 7/31/2019 Check 423283 $0.00
Info Process/Archiving-Lg $2.00 (over 230-0000-43135 $36.00 $36.00 $36.00 7/31/2019 Check 423283 $0.00
11x17)
Info Process/Archiving-Lg $2.00 (over 230-0000-43135 $32.00 $32.00 $32.00 7/31/2019 Check 423283 $0.00
11x17)
Info Process/Archiving -Sm $0.50(up to 230-0000-43135 $61.50 $61.50 $61.50 7/31/2019 Check 423283 $0.00
11x17)
Info Process/Archiving-Sm $0.50(up to 230-0000-43135 $11.00 $11.00 $11.00 7/31/2019 Check 423283 $0.00
11x17)
Permit Fee-Additions,Alterations, 230-0000-43104 $955.35 $955.35 $955.35 7/31/2019 Check 423283 $0.00 ;r
Demolition
Plan Review 230-0000-43106 $620.98 $620.98 $620.98 7/31/2019 Check 422983 $0.00
5.
Plan Review- Fire Life Safety 230-0000-43108 $382.14 $382.14 $382.14 7/31/2019 Check 423283 $0.00
Totals for Fees $6,224.44 $6,224.44 $6,224.44 $0.00 f
f:
i
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T.
i
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f
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
422983 Check 1140 Trinity Community 04/22/2019 $1,602.22
Church
423283 Check 1154 Trinity Community 05/06/2019 $4,622.22
Church
Total Payments: $6,224.44
Balance Due: $0.00
Building Permit Application
Commercial RECEIVED FOR OFFICE USE ONLY
City of Tigard JUL 1 6 2019 Received
Date/By: 7 1��1. I /A •ermitNo 60 fl 1o'y
IN r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
2 Phone: 503-718-2439 Fax: 503-598-196(WY OF TIGARD DateBy: Related Permit:
TIGARD
Inspection Line: 503-639-4175 BUILDING U I LD I N G DIVISION Date Ready/By: Juis: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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 Other: Permit revision equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10900 SW 121 St Ave New dwelling area: square feet
City/State/ZIP: Tigard, Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Trinity Community Church Covered porch area: square feet
Cross street/directions to job site: South of SW Scholls Ferry Rd, Past Deck area: square feet
SW Springwood Dr, East side of street. Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHLCKLIST
Subdivision: Lot#: 7200 Permit fees*are based on the value of the work performed.
Tax map/parcel#:1 S 134 B D 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.
Revision of original permit: New scope of work includes: Valuation: $ 80,000
Repair and reconfiguration of the basement, roof replacement Existing building area:13409 square feet
and repair of the steeple. New building area: 13409 square feet
DO PROPERTY OWNER 0 TENANT Number of stories: 2
Name: Trinity Community Church Type of construction: VB
Address: 10900 SW 121 st Ave Occupancy groups:
City/State/ZIP: Tigard, Oregon 97223 Existing:A-3
Phone:(503)686-3364 Fax:( ) New: A-3
Ni APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: G'I DA (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Leslie Jones
FLS plan review fee(if applicable):
Address: 15895 SW 72nd Ave
Total fees due upon application:
City/State/ZIP: Portland, Oregon 97224
Amount received:
Phone:(503226-1285 Fax: :( )
E-mail:
LeslieJ@cidainc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Yorke & Curtis Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4480 SW 101 st Ave Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton, Oregon 97005 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)646-2123 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB Lic.: 55644 Total fee due upon application: $201.60
Authorized signature: '/J/`6✓ L• �J This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 1....2S11 e Jo✓l.tzS Date: 7 I iSI 1°I * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-46 1 3T(1 1/02/COM/WEB)
FOR OFFICE USE ONLY-SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
R 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
JUL 162019
FROM: tV\0 t r't0✓) CITY OF TIGARD
COMPANY: C 1 BUILDING DIVISION
PHONE:
RE: S L.S r 2 1 )r; 449a -Q2/0`1
(Site Address) (Permit Number)
TIn OtTI (0►v1 r1 1'\)t-rv-) C \.Q tom-A
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
Additional set(s)of plans. 2 Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. 2-. Engineer's calculations.
Other(explain):
} REMARKS: \f EV f se TT) scos)E OF W 0 1= (Zt-_-A>vaD)
FOR OFFICE USE ONLY
Routed to Perml chnician: : — ZZ - Initials:
Fees Due: ❑ Yes Fee Description: Amount D>Ye.
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No ❑ Done
Applicant Notified: Date: 7/ Initials: 0-
1:\Building\Forms\TransnuttalLetter-Revisions_061316.doc
.1 CITY OF TIGARD RECEIPT
1111 g 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Trinity Community Church
Site Address: 10900 SW 121ST AVE
Receipt Number: 423283 - 05/06/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00104 Permit Fee-Additions, Alterations, 230-0000-43104 $2,464.95
Demolition
BUP2019-00104 12% State Surcharge-Building 100-0000-24001 $295.79
BUP2019-00104 DC Provision Review, COM TI- Ping 1 00-0000-431 1 2 $388.00
BUP2019-00104 Plan Review- Fire Life Safety 230-0000-43108 $985.98
BUP2019-00104 Info Process/Archiving-Lg $2.00 (over 230-0000-43135 $36.00
11x17)
BUP2019-00104 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $61.50
11x17)
BUP2019-00104 Metro Const. Excise Tax 230-0000-24010 $390.00
Total: $4,622.22
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1154 BTAGGART 05/06/2019 $4,622.22
Payor: Trinity Community Church
Total Payments: $4,622.22
Balance Due: $0.00
Page 1 of 1
1,1 CITY OF TIGARD RECEIPT
- II
z tt 13125 SW Hall Blvd.,Tigard OR 97223
p 503.639.4171
TICARD
Project Name: Trinity Community Church
Site Address: 10900 SW 121ST AVE
Receipt Number: 422983 - 04/22/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00104 Plan Review 230-0000-43106 $1,602.22
Total: $1,602.22
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 1140 STOLES 04/22/2019 $1,602.22
Payor: Trinity Community Church
Total Payments: $1,602.22
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD '..-4,, --- BUILDING PERMIT
11
11 . COMMUNITY DEVELOPMENT Permit#: BUP2019-00104
T-I i;A i,f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 j. Date Issued: 05/06/2019
Parcel: 1 S 134BD07200
Jurisdiction: Tigard
Site address: 10900 SW 121ST AVE
Project: Trinity Community Church Subdivision: SUMMERBROOK SUBDIVISION Lot:
Project Description: Revision of original permit for new scope of work to include repairing and reconfiguring the basement,roof
replacement,and repair of the steeple.
Contractor: YORKE&CURTIS Owner: TRINITY CHURCH OF THE EVANGELICAL
4480 SW 101ST AVE 10900 SW 121ST AVENUE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 646-2123 PHONE:
FAX: FAX 643-5531
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review,COM TI-Ping 05/06/2019 $254.00
Occupancy Grp: B Occupancy Load: 135 Permit Fee-Additions,Alterations, 05/06/2019 $955.35
Demolition
Dwelling Units: 0 12%State Surcharge-Building 05/06/2019 $114.64
Stories: 0 Height: 0 ft Plan Review 04/22/2019 $620.98
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 05/06/2019 $382.14
Value: $80,000 Info Process/Archiving-Lg$2.00(over 05/06/2019 $36.00
11x17)
Info Process/Archiving-Sm$0.50(up to 05/06/2019 $61.50
Floor Areas: 11x17)
Info Process/Archiving-Lg$2.00(over 05/06/2019 $32.00
Total Area: 0 11x17)
Accessory Struct: 0 Info Process/Archiving-Sm$0.50(up to 05/06/2019 $11.00
Basement: 0 11x17)
Carport 0 Additional Plan Review 04/22/2019 $90.00
Covered Porch: 0 Cash Over 05/06/2019 $3,666.83
Deck: 0
Garage: 0
Mezzanine: 0
Total $6,224.44
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
1 Special Inspection(see plans)
-- Protected Corridors- -- -- -- — ---
r _ __,:t
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: .„,• °#.' i - „:„..r.,,, ,. . ee Signature: C1rA 6LGG�
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
Commercial RECEIVED ED FOR OFFICE USE ONLY
City W Tigard J U L 1 6 2019 nateisey %C"77: F .ermitNo 4, t:,//7'--i6, f
_ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �J.y 1
Phone: 503-718-2439 Fax: 503-598-196�ITY OF TIGARD Date/By: �,L Related Permit:
Inspection Line: 503-639-4175 Date ReadyBy: Awls. H See Page 2 for
TIGARD p BUILDING DIVISION 7/� I
Internet: www.tigard-or.gov otifieead o 0 See Page 2 Information
TYPEff/(
'et
'OF WORK .„' 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 N Other: Permit revision equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 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: 10900 SW 121St Ave New dwelling area: square feet
City/State/ZIP: Tigard, Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Trinity Community Church Covered porch area: square feet
Cross street/directions to job site: South of SW Scholls Ferry Rd, Past Deck area: square feet
SW Springwood Dr, East side of street. Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot#: 7200 Permit fees*are based on the value of the work performed.
Tax map/parcel#:1 S 134 B D 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.
Revision of original permit: New scope of work includes: Valuation: $ 80,000
Repair and reconfiguration of the basement, roof replacement Existing building area:13409 square feet
and repair of the steeple. New building area: 13409 square feet
D4 PROPERTY OWNER 0 TENANT Number of stories: 2
Name: Trinity Community Church Type of construction: VB
Address: 10900 SW 121st Ave Occupancy groups:
City/State/ZIP: Tigard, Oregon 97223 Existing:A-3
Phone:(503)686-3364 Fax:( ) New: A-3
NI APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: .,IDA
Structural plan review fee(or deposit):
Contact name: Leslie Jones
FLS plan review fee(if applicable):
Address: 15895 SW 72nd Ave
Total fees due upon application:
City/State/ZIP: Portland, Oregon 97224
T Amount received:
Phone:(503}226-1285 Fax::( )
E-mail: LeSIIeJgCIdaInC.COm PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Yorke & Curtis Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4480 SW 101st Ave Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton, Oregon 97005 Permit fee(includes plan reviej $180.00
and administrative fees :
Phone:(503)646-2123 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.: 55644Total fee due upon application: $201.60
Authorized signature: 71f This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: �St e Jo vue_S Date: ' (sl lei * 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)
I
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
INII Accessibility: Barrier Removal Improvement Plan
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] $ 80,000
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 20,000
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: (Included in Site Work Permit) $ 50,000
(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): $
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
II
City of Tigard
mg
II 111
COMMUNITY DEVELOPMENT DEPARTMENT
T l c It o Building Permit Review — Commercial - No Land U s e
Building Permit #: Lk>2rC;\C\-O0\0,4
Site Address: /D 960 -2 /2/ ,L Suite/Bldg#:
Project Name: l rip," are -_ Jge.vi rr ce-c e r%,}- Lam✓k:. y/Cf_r�i
(Name of o ercial business occupying the space. If vacant,enter Spee Space.)
Planning Review / /f
Proposal: �C P M o iat'.,J rrP,G ..ba-,°k Jf ...42" —e - &LAU QJ�
Lck g �n �A- r . 4,93- ) e i,et
l n-1-7.--
Existing Business Activity: I' 101,! 7nl�-
Pro. ed Business Activity: l� //
PA Verify site address/suite#exists and active in permit syst
f' 'ver Terrace Neighborhood: ❑ Yes UZJ No
fining: aC zf
rmitted Use: Yes El Spec Space
❑ No
C' no land use re uired.
Business License:
Exists: Yes ❑ No,applicant notified to obtain business license ,
Notes:
Approved by Planning: ,-- Date:
_1 Avg-/, /
Revisions (after Bing Submittal only) viewer Date
Revision 1: Approved ❑ Not Approved 7-1(-1,1
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: 4 t"..," .(Act
Site Plans: # 3
Building Plans:
# 3
Building Permit#: 2'Enter building permit#above.
Workflow Routing: Er Planning Permit Coordinator C` Building
Workflow Sign-off: []'Sign-off for Planning(include notes from planning review)
Route Application Documents: [a'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: ,,__, Date: 41T-\lc,
i
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_060116.docx
r w
Permit Coordinator Review
El 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:
.7,,8C Fees Entered: Wash Co Trans Dev Tax: ❑ Y6S /A
Tigard Trans SDC: 0 Yes Al-/2:A
/
Parks SDC: 0 Yes
OK to Issue Permit / /1 2 L
Approved by Permit Coordinator: , Date• �f " Ll
i
j
I
1:\Building\Forms\B1dgPermitRvw COM_NoLandUse 070915.docx
CITY OF TIGARD 1 . i. BUILDING PERMIT
"' ii,1 ' COMMUNITY DEVELOPMENT ' 2,.. Permit#: BUP2019-00104
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
7 t c,A R[7 Parcel: 1 S134BD07200
Jurisdiction: Tigard
Site address: 10900 SW 121ST AVE
Project: Trinity Community Church Subdivision: SUMMERBROOK SUBDIVISION Lot:
Project Description: Repairing/reconfiguring basement,new site steps from sidewalk grade to entry,new ADA ramp,new entry canopy,
and roof replacement. 6/4/19: REPRINT to correct owner information.
Contractor: YORKE&CURTIS Owner: TRINITY CHURCH OF THE EVANGELICAL
4480 SW 101ST AVE 10900 SW 121ST AVENUE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 646-2123
PHONE:
FAX: FAX 643-5531
FEES
Specifics:
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 05/06/2019 $2,464.95
Demolition
Occupancy Grp: B Occupancy Load: 135 12%State Surcharge-Building 05/06/2019 $295.79
Dwelling Units: 0 Plan Review 04/22/2019 $1,602.22
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 05/06/2019 $388.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 05/06/2019 $985.98
Value: $325,000 Info Process/Archiving-Lg$2.00(over 05/06/2019 $36.00
11x17)
Info Process/Archiving-Sm$0.50(up to 05/06/2019 $61.50
Floor Areas: 11x17)
Metro Const.Excise Tax 05/06/2019 $390.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $6,224.44
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 Special Inspection(see plans)
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 ules 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. 0.33 344.
Issued By: �' a Signature:
Ai �.1i[L!I %/ . .
V 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.
CITY OF TIGARD BUILDING PERMIT
III COMMUNITY DEVELOPMENT
Permit#: BUP2019-00104
GAT1fg D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
Parcel: 1S 134BD07200
Jurisdiction: Tigard
Site address: 10900 SW 121ST AVE
Project: Trinity Community Church Subdivision: SUMMERBROOK SUBDIVISION Lot:
Project Description: Repairing/reconfiguring basement,new site steps from sidewalk grade to entry,new ADA ramp,new entry canopy,
and roof replacement.
Contractor: YORKE&CURTIS Owner: WILLOW CREEK LAND LLC
4480 SW 101ST AVE PO BOX 1060
BEAVERTON, OR 97005 WOODBURN, OR 97071
PHONE: 646-2123 PHONE:
FAX: FAX 643-5531
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 05/06/2019 $2,464.95
Demolition
Occupancy Grp: B Occupancy Load: 135 12%State Surcharge-Building 05/06/2019 $295.79
Dwelling Units: 0 Plan Review 04/22/2019 $1,602.22
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 05/06/2019 $388.00
Bedrooms: 0 Bathrooms: • 0 Plan Review-Fire Life Safety 05/06/2019 $985.98
Value: $325,000 Info Process/Archiving-Lg$2.00(over 05/06/2019 $36.00
11x17)
Info Process/Archiving-Sm$0.50(up to 05/06/2019 $61.50
Floor Areas: 11x17)
Metro Const.Excise Tax 05/06/2019 $390.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $6,224.44
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
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 co• • - or direct questions to OUNC by calling 503.232.1987 or 1.:$0.332.2344.
Issued By: Permittee Signature: i .
Call 07 9.4175 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
Commercial RECEIVED FOR OFFICE USE ONLY
Received
. City of Tigard _r' Permit No: C yy t,
Tigard APR 2 2 2 019 DateBY: `1't�� t\LI �,� � �`"\"�.�\U`�r
'� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review e Related Permit:
Phone: 503-718-2439 Fax: 503-598III / Date/By: 4S--Gas ) 9,
Inspection Line: 503-639-4175 ° ' OF IIUPtIIL) Date Ready/By: 1 : El See Page 2 for
TIGARD g g BUILDING DIVISION l7i� — Supplemental Internet: www.ti and-or. ov otiSed/Method: 5 Su lementalInformation
TYPE OF WORK REQUIRED DATA:1-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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling r4Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
1:1 Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1(}1C)Q 51t4 12.1 Sr IkvE New dwelling area: square feet
City/State/ZIP: 1\(,\ptZD p k 0 i C11 Z23 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: TczWrt,) Cor k\J ji-r, C1-1\lvetvi Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
5 SLJ S G\A t$1\S e.,,,,-,) v..a, J JS-t QpS"f Other structure area: square feet
51".1 SenrIc)wo04A )r j 'E -t 514t o ' 6 -y.t . REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: ( Lot#: 9-Zo c) Permit fees*are based on the value of the work performed.
Tax map/parcel#: ft g�'Zj!�S Q 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: $ 325,0 oo
Tx.vzIv/tZec.DAVtc�.vcatt n .oc 66► nev,-t/t.3tl,.i Site_. St-cps -
1^t 5,ta..vlut.K. C)(C -tri eJA-t 71 t 1 C.4.1 P Pi Existing building area: 13 L0 square feet
PI/t'I VI c�V10 py. �{boc Ck..ylu e etn'1".. New building area: square feete-}--1
jEl PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: -I-V..14.1111 C O1NA1n1Vt. -t1 C>n‘It(.\1 Type of construction: V f3
Address: 1c,,�ob 51n) 121 sr Ave, Occupancy groups: _5
City/State/ZIP: nfi(,x+rUck _. cI rZ2 ' Existing: 5,43)44E- (A_3)
Phone:(5e3) lo'p,(a— 33(ø t} Fax:( ) New: 5/4 Yv1 t= CA-3)
I APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: G t tj IN
Structural plan review fee(or deposit):
Contact name: LESt.2 E -sd tJES FLS plan review fee(if applicable):
Address: 1 61395 51.t `3'Z Mt4 IN v 5t)I T�arD c>.
City/State/ZIP: Total fees due upon application:
rocTLt�tvo 012. q�ZZy Amount received:
Phone:(5D3) 2.ZC5-1-its Fax::( )
E-mail: LESLIE-- ,� G 1I,Iq 1NC..- Cdivl PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ',./C) }[ ;r CU\2Ti s Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: t1-LFBD 51„3 I G 1 ST Ave Solar Installation S ecial Code checklist.
Permit fee(includes City/State/ZIP: gCZv��t-ori Co(?._, cf3ODS . . $180.00
nistrative fees):
Phone:(503) ( L/(v— z 1 z 3 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.: 55 6,y1( Total fee due upon application $201.60
Authorized signature: This permit application expires if a permit is not obtained
v4 ii& , within 180 days after it has been accepted as complete.
Print name: $iveE b. PT SD/-/ Date: 4t/$Z/`? * 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
111111 41 Accessibility: Barrier Removal Improvement Plan
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] $ 3 )5,ooa
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ }$�-456
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: $ 58, 1-5c)
(c) An accessible route to the altered area: $ Z®j O0 C
(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): $
I:\Building\Pemuts\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard
N COMMUNITY DEVELOPMENT DEPARTMENT
■
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: LL> \C-00\04
Site Address: /0 900 1AJ Suite/Bldg#:
Project Name: l tin/. P &t� ek--
(Name of Fo ercial business occupying the space. If vacant,enter Spec Space.)
Planning Review / q ),,
t(
Proposal: Q/J'+ala`i'r' /,,, o��i ,e_k_ l ,,,/l ,a ,L -e ,\ Q1c
7
`� S A i d r
Existing Business Activity: IO-g, /)/g."7 A{/Jn1L
Pro.• ed Business Activity: J // //
FA Verify site address/suite#exists and active in permit�s�yst
f►' . 'ver Terrace Neighborhood: El Yes Yes No
V.zo-ning: e-1f
Viiii rmitted Use: Yes ❑ No ❑ Spec Space
2 no land use re uired.
Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: �- Date: 2/ 1, j
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: El Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 4 t A t lG
Site Plans: # 3
Building Plans: # 3
Building Permit#: V Enter building permit#above.
Workflow Routing: [?(Planning e Permit Coordinator Building
Workflow Sign-off: [-Sign-off for Planning(include notes from planning review)
Route Application Documents: 2/Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: J��l Date: 4.t �..,tci
I:\Building\Forms\BldgPermitRvwCOM NoLandUse o6o116.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:
C Fees Entered: Wash Co Trans Dev Tax: ❑ Y6s /A
Tigard Trans SDC: ❑ Yes
Parks SDC: ❑ Yes LT N/A
OK to Issue Permit
Approvedby Permit Coordinator: *k:oate: 4` [ L/
I:\Building\Forms\BldgPermitRvwCOM NoLandUse_070915.docx