Permit (3) CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2019-00273
Date Issued: 10/22/2019
T I G j\R ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10105 SW NIMBUS AVE
Project: Burger King Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Exterior façade improvements and interior renovation for existing restaurant.
Contractor: KBBL Owner: ROBINSON, JERRY CHRISTOPHER TRUS
12308 CHECKERBOARD ROAD NE DIETRICH, NANCY BISHOP
GERVAIS, OR 97026 9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-586-3767 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VBDC Provision Review,COM TI-Ping 10/22/2019 $254.00
Occupancy Grp: B Occupancy Load: 58 Permit Fee-Additions,Alterations, 10/22/2019 $1,105.95
Demolition
Dwelling Units: 12%State Surcharge-Building 10/22/2019 $132.71
Stories: Height: ft Plan Review 10/22/2019 $718.87
Bedrooms: Bathrooms: Plan Review-Fire Life Safety 10/22/2019 $442.38
Value: $100,000 Info Process/Archiving-Lg$2.00(over 10/22/2019 $50.00
11x17)
Info Process/Archiving-Sm$0.50(up to 10/22/2019 $6.00
Floor Areas: 11x17)
Metro Const.Excise Tax 10/22/2019 $120.00
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $2,829.91
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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. T is 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 t - rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9 !01-00•0, You m •btain a �•y of the rules or direct questions to OUNC by calling 5,01E1)987 987 or 1.800 332.2344.
Issued By: _ / A ���� Permittee Signature:,,._ ..
Call 503.639.41 5 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 FOR OFFICE USE ONLY
City of Tigard Date/By:Received 4/,Zs( // I / Permit No.: t109 iei
- A 13125 SW Ha11 B1vd.,Tigard,OR 97223 SEP 1 7 2 0 1 9 Plan Review WI
Phone: 503-718-2439 Fax: 503-598-1960 Date/By: 9 �„6— , Related Perm t:
TIGARD, Inspection Line: 503-639-4175 t. i(Y ' i-' I 1G A -U Date Ready/By: Juris: Ea See Page 2 for
: Internet: www.tigard-or.gov3 _II_." Notified/Method: 0 7 t4 i/ Supplemental Information
CO/Svvit 04l, /.. ►r 3atv44
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
M Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling M Commercial/industrial Valuation: $
111 Accessory building El Multi-family Number of bedrooms:
❑Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10105 SW NIMBUS AVE. New dwelling area: square feet
City/State/ZIP: TIGARD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name:BURGER KING #5282 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW NIMBUS AVE./ SW SCHOLLS FERRY RD. Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot 4: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 1 S 134AA01900 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.
EXTERIOR FACADE RENOVATION & INTERIOR Valuation: $ 100,000
DINNING ROOM Existing building area: 3,768 square feet
New building area: 0 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: AMBROSIA QSR Type of construction: VB
Address: 522 SW FIFTH AVE, SUITE 925 Occupancy groups:
too City/State/ZIP: PORTLAND , OR 97204 Existing: A2
Phone:(619)572.0857 Fax:( ) New: A2
APPLICANT 1=1 CONTACT PERSON BUILDING PERMIT FEES*
Business name: ARM ET DAVIS NEWLOVE ARCHITECTS (Please refer to fee schedule)
Structural plan review fee(or deposit):
CIN Contact name: JOHN DODSON, (OR 6623)
FLS plan review fee(if applicable):
% Address: 1330 OLYMPIC BLVD.
City/State/ZIP: SANTA MONICA, CA 90404 Total fees due upon application:
Phone:(310)452.5533.X204 Fax: :( ) Amount received:
E-mail: DODSON ADNARC.COM PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: T.B.D .` $L/ 1�� Submit two(2)sets of roof plan with connection details
j and fire department access,along with the 2010 Oregon
Address: /7.....3"0 C°,j e_c_ka-,',a r?a rd /n I E Solar Installation Specialty Code checklist.
City/State/ZIP: 4.Vji V et,'S ` d tet'7 Permit fee(includes plan review $180.00
/ and administrative fees):
Phone:(s)3) ys/Z _z ZO 3 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 251r. 7/ 375 Total fee due upon application: $201.60
Authorized signature: -- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: JOHN DODSON Date:09/16/19 * 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
1111 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] $ 100,000
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 25,000
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 $ 11,000
(b) An accessible entrance: $ 4,000
(c) An accessible route to the altered area: $ 5,000
(d) At least one accessible restroom for each sex or a single unisex
restroom: $ 5,000
(e) Accessible telephones: $ N/A
(f) Accessible drinking fountains:and, $ N/A
(g) When possible,additional accessible elements such as storage and
alarms: $ N/A
TOTAL(shall equal line [2] of Valuation Computation): $ 25,000
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard
III " COMMUNITY DEVELOPMENT DEPARTMENT
C .
TIGARD Building Permit Review — Commercial - With Land Use
Building Permit #: 8/19,;20f- W0173
Site Address: /0/05 5-2,,i /WrI Suite/Bldg#:
Project Name: / //V
ame commercisioccupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: F.„)ct nor 1110f Acc t.�.
`14 Verify site address/suite#exists and active in permit system.
At River Terrace Neighborhood: ❑ Yes g No
K Land Use Case#: M MD2o toi- OD022
la-Plans Match Approved Land Use:
Z Site Plan lg. Landscape Plan ❑ Other:
MA–Urban Forestry Plan -Elevation Plan
IL Building Height: Maximum Height Actual Height
C: Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
..Business License:
Exists: Xt.Yes ❑ No,applicant notified to obtain business license
'Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified ¢t. No Applied For: CI Yes ❑ No,stop intake
Notes: /
Approved by Planning: Date: A 1'7S 119
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: th ry
Site Plans: #
Building Plans: # �
Building Permit#: n-��t building permit#above.
Workflow Routing: `tTPla -' g [c rigineering &I.-Ter—mit Coordinator [ _ ding
Workflow Sign-off: S[ ign-off for Planning(include notes from planning review)
Route Application Documents: [1--�uilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date: dj i7y
I:\Building\Fonns\BldgPennitRvw COM Withl..andUse 060116.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
El 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: El Yes LNo
Assess Water Quantity Fee in-lieu: ❑ Yes I"No
LIDA Facility on lot: ❑ Yes R"No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: .--4e/ Date: 9/7zh
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: 0 Approved El Not Approved
Revision 3: ❑ Approved El 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: �/
SDC Fees Entered: Wash Co Trans Dev Tax: El Yes Lam`'''N1�T,,,////A
Tigard Trans SDC: El Yes A
Parks SDC: El Yes LE N/A
OK to Issue Permit
Approved by Permit Coordinator: //fDate: ' /'1T
1:\Building\Forms\B1dgPermitRvw_COM_W ithLandUse_070915.docx