Permit (78) RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
al JAN 7 2020
Request for Permit Action
CITY OF TIGARD
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigN11590 DIVISION
TO: CITY OF TIGARD Vj
Building Division `
13125 SW Hall Blvd.,Tigard,OR 97223 ��O/�
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner 4 Applicant ,4 Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) ,k/ &L
OS
Mailing Address: 274)LI y I U .V V. 7....1-1 '~
City/State/Zip: To vT'{-a.u.,clk Osic o;— c\-11 10
Phone No.: Sj�'-- - GG ' �1
- ,1 ' 1 b
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
frig REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: B ) Z0 'C\ - o(J' 3
Site Address or Parcel #: (((---1Q c Nt\i. RL W oo x I r - 00
Project Name: Krnc) ,(\ ,-e,\3 l . C 'o,ov.
Subdivision Name: \CAc-q) - &-k g \Zy\Aiu-, e1 t\ Lot#:
EXPLANATION: (..,\.rk 0-A. )os\. 4)--t..Jc LLit -
Signature: // ✓ ( "1 --7�J Date: 1 I -71 ` O Z,O
Print Name: Matk (. ` 0 A-it s
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
c5C7, y6 — 615':9 ; /2/, Y9
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date </J3 By .F i
Refund Processed: Date /�/� ?Gr +r By�Invoice Processed: Date // By
Permit Canceled: Date,iet 1p7c By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_12 18.doc
u
TIGARD
City of Tigard
January 28, 2020
Mark Beckius
2344 NW 24th
Portland, OR 97210
Re: Permit No. BUP2019-00163
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 6640 SW Redwood Ln, Ste 200
Project Name: Portland Clinic
Job No.: N/A
Refund Method: ® Check#234433 in the amount of$768.29.
❑ Credit card"return"receipt in the amount of$
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): Per applicant's request as client lost their lease. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
0S5)(207‘.71--C__
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
r G �i 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: Mark Beckius DATE: 1/17/2020
2344 NW 24th
Portland, OR 97210 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 424849 Case#: BUP2019-00163
Date: 7/24/2019 Address/Parcel: 6640 SW Redwood Ln,Ste 200
Pay Method: CreditCard Project Name: Portland Clinic
EXPLANATION: Per applicant's request as client lost their lease. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Building Permit 230-0000-43104 $685.97
12%State Surchage 100-0000-24001 82.32
TOTAL REFUND: $768.29
APPROVALS: SIGNAT ES ATE:
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: 9/3`2-/ By: "a9C,)
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
44
13125 SW Hall Blvd.,Tigard OR 97223
.1111
503.639.4171
TIGARD
Project Name: Portland Clinic
Site Address: 6640 SW REDWOOD LN 200
Receipt Number: 436193 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00163 $-768.29
Total: $-768.29
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 234433 DHOWSE 09/03/2021 $-768.29
Payor: Mark Beckius
Total Payments: $-768.29
Balance Due: $768.29
Page 1 of 1
11
CITY OF TIGARD RECEIPT
• 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGAS D
Project Name: Portland Clinic
Site Address: ' 6640 SW REDWOOD LN 200 0 f(6
j
Receipt Number: 424849 - 07/24/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00163 Permit Fee-Additions, Alterations, 230-0000-43104 1. )41 $857.46 E
Demolition
BUP2019-00163 12% State Surcharge-Building 100-0000-24001 en 170 $102.90 <`
BUP2019-00163 DC Provision Review, COM TI- Ping 1 00-0000-431 1 2 $102.00
BUP2019-00163 Plan Review-Fire Life Safety 230-0000-43108 $342.98
BUP2019-00163 Info Process/Archiving- Lg $2.00 (over 230-0000-43135 $10.00
11x17)
Total: $1,415.34
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 014265 BTAGGART 07/24/2019 $1,415.34
Payor: Mark Beckius
Total Payments: $1,415.34
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2019 00163
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2019
Parcel: 2S 112DA01300
Jurisdiction: Tigard
Site address: 6640 SW REDWOOD LN 200
Project: Portland Clinic Subdivision: 1996-048 PARTITION PLAT Lot: 1
Project Description: Remodeling the lab on the second floor.
Contractor: REIMERS &JOLIVETTE INC Owner: PACIFIC REALTY ASSOCIATES
2344 NW 24TH AVE ATTN: N PIVEN
PORTLAND, OR 97210 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-228-7691 PHONE: 503-221-0161
FAX: 503-228-2721
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIA Permit Fee-Additions,Alterations, 07/24/2019 $857.46
Demolition
Occupancy Grp: B Occupancy Load: 23 12%State Surcharge-Building 07/24/2019 $102.90
Dwelling Units: 0 Plan Review 07/10/2019 $557.35
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 07/24/2019 $102.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 07/24/2019 $342.98
Value: $66,400 Info Process/Archiving-Lg$2.00(over 07/24/2019 $10.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,972.69
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire arm: 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 for in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct.uestions to OUNC by calling 503.23 .1 87 or 1.800.332.2344. /
r /
Issued By: -- ' mittee Signature: x (1,/-
Call .6 5 by 7:00 a.m.for the next available inspection date.
Thls 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 1:014 OFFICE ISI'ONLY
City of Tigard E!'ew7
�G / ' P t �� (Y6,
11111 44 313125 SW Hall Blvd.,Tigard,OR 97223 J1 019
= Phone: 503-718-2439 Fax: 503-59 -1960 I Date/By: �' I) Related Permit:
T I G A R I� Inspection Line: 503-639-4175 GG I TY OF T I G AR D Date Ready/By' ,......':1/ Jana: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVE'DIVISION
•tified/Me ,. Supplemental Information
i 6�7fsJf� , %,�
/ c&rwA
TYPE OF WORK REQUIRED DATA;1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
1`Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling 'Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ( , 0 5 " pc vtcsU ,arc New dwelling area: square feet
.
City/State/ZIP: a>,\'\-t, \ 04... Ot-- . -ClZZLk Garage/carport area: square feet
Suite/bldg./apt.#: Aa7-3 Project name:) Ay\.\,,,, ,, 6;r;` Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
",' REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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.
D,r • c\Ow \"Z]p \2w%o t7,c 1 Valuation: $ (0(1 y 60 U"
Existing building area: )1gC-\fl square feet Uma Td
New building area: —. square feet --�-' l
❑ PROPERTY OWNER "TENANT Number of stories: 3
Name: To,1,\...4_,, , C. W.S f Type of construction: \\-A
Address: ?b() S.x Y , nAA-- Occupancy groups: U7 \c\\„\ o t,c5
City/State/ZIP: rr11. O O�. Existing:
Phone:(5-03 ) --/-6-V\�\ ---(T-0.-4 Fax :() New:
APPLICANT 0,CONTACT PERSON BUILDING PERMIT FEES*
Meese refer toJee schedule,)
1/ h
Business name: rLcc $ \ pI' VL �L
\ Structural plan review fee(or deposit):
Contact name: \aY� SCC.Kius
t� FLS plan review fee(if applicable):
Address: Z� 11 1�\NN . -7j\'
nO
\ \ OX.,
� CA'11\/\ Total fees due upon application:
,
City/State/ZIP: �1' 1 w-d� V
—__ y Phone:$ ) R •L _�.__ .. _. .1 Amount received:
1 (n� \\ P'EU1 VOL`I"AIC'SOLAITPA'NEL'SY'STEM ESw
E-mail:
r1'„V� C Y6\r,„vs-ay.0 0)ivL..4C o CUvv1
CONTRALOR Commercial and residential prescriptive installation of
roof-top mounted Photo Voltaic Solar Panel System.
Business name: Rc‘i,.�e-v\ ' J O\.u c1�` Submit two(2)sets of roof plan with connection details
l, and fire department access,along with the 2010 Oregon
Address: t-y N N•1, 2`I''" Solar Installation Specialty Code checklist.
City/State/ZIP: (?(..30 1.v,� Vv v,, C.-0.1,\O Permit fee(includes plan review $180.00
Phone:(5C3 ) 1:1... ,- '")��` Fax: and administrative fees):
( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: \\L\y ',/a/
S J Total fee due upon application: $201.60
Authorized signature:
//f.,/,,,ii J C This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: )\/1-0.A.... V ���u 5 Date: 81�t \ * 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
1111 COMMUNITY DEVELOPMENT DEPARTMENT
■
r1cARo Building Permit Review — Commercial - No Land Use
Building Permit #: ju,,Gt ,' C)/ '_.)
Site Address: (0(040 SW ReeiwpcxA he_., Suite/Bldg#:
Project Name: P0122 HGvla CIi i 1 is
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: T, I .
Existing Business Activity: .c i C4 o Ce_
Proposed Business Activity: i% 14
VVerify site address/suite# exists and active in permit system.
River Terrace Neighborhood: ❑ Yes t' No
0 Zoning: t- .p
12/ Permitted Use: Yes ❑ No ❑ Spec Space
Jl Confirm no land use required.
Business License:
Exists: Igi Yes ❑ No,applicant notified to obtain business license
Notes: ilryll -ke-tuutAt _.h O C� (. t ul&sC-
Approved by Planning: Arpkio O .l' - Date: 7 110 1 19
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: 77(0//7
Site Plaits. --- _ -
Building Plans: •
Building Permit#: Enter building permit#above.
Workflow Routing: r. lanning _ ermit Coordinator Building
Workflow Sign-off: Sign-off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: �ff. i Date: d
7
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:
VDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ri /
Tigard Trans SDC: ❑ Yes C1 A
Parks SDC: ❑ Yes rm N/A
OK to Issue Permit
Approved by Permit Coordinator: gflDate: /"/1q I
I:\Building\Forms\B1dgPermitRvw_COM NoLandUse_070915.docx