Permit CITY OF TIGARD BUILDING PERMIT
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» COMMUNITY DEVELOPMENT Permit #: BUP2010 00258
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2010
Parcel: 2S102AC00800
Jurisdiction: Tigard
Site address: 12555 SW MAIN ST
Project: MyConnect LLC Subdivision: Lot: 0
Project Description: Review for change of use and occupancy only. 12/8/2010: No Certificate of Occupancy to be issued until building
plans submitted and approved for partition wall constructed and electrical work done without permits, and for
structural repairs required to floor beam with all work to be performed by licensed contractors per Building Official.
Contractor: Owner: HEUVELHORST, MICHAEL J
C/O KADEY, GEORGE S JR
12551 SW MAIN ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 12/03/2010 $53.27
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 12/03/2010 $6.39
Stories: 0 Height: 0 ft Plan Review 11/23/2010 $34.63
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 11/23/2010 •$21.31 -
Value: $500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $115.60
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ,N /97 e 4
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
R rick,fiuvcili FOR OFFICE USE ONLY
City of Tigard NOV 2010 Date/By: // � � t �. Permit No 4, /o JO e 5 f
'
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie1 1 , c �
' Phone: 503.639.4171 Fax: 503.598.196 DateB : Y AA
1 • 60 Other Permit:
�
Inspection Line: 503.639 CITY OF TIGARD Date Read: lids ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: /1 /O it / Supplemental Informati 1 TIGARD on
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
411 ddition/alteration / replacement -1/ they: ai 0c /i clo ce0 equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION / work indicated on this application.
Valuation: $ ' v 8'. ,,;
❑ 1 - and 2- family dwelling Commercial /industrial
❑ Accessory building Ill Multi-family Number of bedrooms:
❑ Master builder I=1 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: /
Job site address: g cj, — ` j 5 M At' N .'S — # Er New dwelling area: square feet
City /State /ZIP: 671 go criz q'7 1 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Ar\.1 ( :, e) tc-f (IC Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
H y cici / f f$IN ;.5 r. Other structure area: square feet
{ REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work
Tax map /parcel no.: 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.
e if 4 v&-E Or Vac() p pwc y 4 u Valuation: $ 5 0 0
Existing building area: 76 square feet
New building area: 0 square feet
❑ PROPERTY OWNER TENANT Number of stories: /
Name: 111 Et "7o, •)r_S Type of construction:
. Address: t z ' f ' � °
Address: / d ,.,, „J � ! 'd) ���, -/' /L/ -`277:E7-rf- Occupancy groups:
City /State /ZIP: 171,A42 / l (II AA 1/ Existing:
-
Fa x: ( )
Phone: (5 3) '
(56 ii, c,l 9.5 New:
'R APPLICANT ❑ CONTACT PERSON NOTICE
Business name: AA/ ec�,ti —? y LL €L All contractors and subcontractors are required to be
Contact name: j licensed with the Oregon Construction Contractors Board
/e rT L e`� under ORS 701 and may be required to be licensed in the
Address: 12 S-5--s- -S W /144-pv _; . - jurisdiction in which work is being performed. If the
City/State /ZIP: ( �+ n C' 7 applicant is exempt from licensing, the following reasons
G� ` \ apply:
Phone: (563) 936z- 16-0, ,S— Fax:: ( )
E -mail:
CONTRACTOR
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule
Structural plan review fee (or deposit):
City /State /ZIP:
FLS plan review fee (if applicable):
Phone: ( ) Fax:( )
Total fees due upon application:
CCB lic.:
Amount received: . 37 . 5', 9y
Authorize 'signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: nikhc`e. ` � .c S Date: , )/2?//O * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building \Permits \BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
a
114 Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
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 per -cent (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): $
I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08
Building Division
Plan Submittal Requirements
T I G A R D Commercial & Multi - Family - New, Additions or Alterations
1. SITE PLAN (fully dimensional, drawn to scale) labeled with:
A. ❑ map & tax lot # ❑ project name il site address ❑ suite number
TA zoning U' applicant name g phone number
B. North arrow.
Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking, including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape -ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations, plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit - based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
I: \Building \Permits \BUP -COM PcrmitApp.doc 06/25/08
Building Division
Plan Submittal Requirement Matrix
T I GA R D Commercial & Multi- Family - New, Additions or Alterations
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 2
Fire Protection System 2
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington
County, and Tualatin Valley Fire & Rescue)
I: \ Building \Permits \BUP -COM PermitApp.doc 06/25/08