Permit 1
P CITY OF TIGARD BUILDING PERMIT
° ,- COMMUNITY DEVELOPMENT Permit #: BUP2009 -00116
Date Issued: 09/30/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102DA00200
Jurisdiction: Tigard
Site address: 8720 SW BURNHAM ST
Subdivision: Lot: 0
Project: Skate Park Restroom
Project Description: Public restroom
Owner: FEES
TIGARD, CITY OF Description Date Amount
13125 SW HALL BLVD Permit Fee - COM 07/14/2009 $366.70
TIGARD, OR 97223 12% State Surcharge - Building 07/14/2009 $44.00
PHONE: Plan Review 07/14/2009 $238.36
Plan Review - Fire Life Safety 07/14/2009 $146.68
•
Contractor:
CENTREX CONSTRUCTION INC
8250 SW HUNZIKER RD
TIGARD, OR 97223
PHONE: 503 - 684 -0443
FAX: 503 - 620 -6692
Specifics:
Type of Use: COM
Class of Work: ACS
Dwelling Units:
Stories: 1 Height: 12 ft
Bedrooms: Bathrooms: 2
Value: $50,000
Floor Areas:
Total Area:
Accessory Struct: 150
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $795.74
Required: Required Items and Reports (Conditions)
Fire Sprinkler: No Parapet: No
Fire Alarm: No Protected Corridors: No
Smoke Detectors: No Manual Pull Stations: No
Accessible Parking: 1
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 ore the 180
days. ATTE a ,: Oregon . requi ou to follow the rules adopted by the Oregon Utility Notification Ce e . hose rules are set forth in e
952 -001 -0.10 through OAR 952 - • 1 -0100 - may obtain a copy of the rules or direct questions to OUNC r calli . 503.246 6699 •' 1.800.3 344.
Issue By: J / A l ` /IL g• r Permittee Signature:
• ,_■..i_011111111■■-___ I.A i
Call 503.639.4175 by 7:00 a.m. for an inspection that b siness day.
This permit card shall be kept in a conspicuous place on the job site until completion o e project.
Approved plans are required on the job site at the time of each inspection.
t (A 67c 0 tk i ?- ,6°Cfq
P Building Permit Application . M
w
Commercial !:'OR OFFICE USE ONLY
E Receied / l City of Tigard Date/by: l/ I Q Permit No.: �Q�� /� /mil
7
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review'\ 1 777"'���
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By: �� iA . f Other Permit:
I Line: 503.639.4175 JUN 1 2009 Date Remy : y: / ( "1 ------ Supplemental ® See Page 2 for
CIGAR g g 7 / !�0 ` (G-
Internet: www.ti azd -or. ov Not ifie� lnformation
CITY OF TICARD w �-e,
u Sao iti 0 i� VY It ',tt
TYPE OF WORK II / '. �/t - I QUIRED DATA: 1- AND 2- FAMILY DWELLING
["New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
El Addition/alteration/replacement El Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CO work indicated on this application.
El _ NS ST� TRUCTION 1- and 2- family dwelling Commercial /industrial Valuation: s ,' ®per
❑ Accessory building 111 Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms: a
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ' 7R O 6 1-t� B aeN )-f 4 /y, New dwelling area: square feet / ?.2
City /State /ZIP: 7^ / p � f` Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 5 jeu•*_ 1.-7( / LA' /, 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: I Lot no.: Permit fees* are based on the value of the work performed.
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.
Valuation: $ 5C9 / Ll ‘0
Existing building area: square feet
New building area: square feet f5- Q
O PROPERTY OWNER ❑ TENANT Number of stories:
Name: e_ / . yy%,, ,ed Type of construction:
Address: / 2.5 5 i..4._) 1�� / / Occupancy groups:
City /State /ZIP: 7-i y «,e ci co Existing:
Phone: 6Y'3) 7/ 62 ,2_4,,e,.."
.5 Fax:,P3) e, y t r ' 7 2 New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: .. ! ) J. .y-/ y s1R c All contractors and subcontractors are required to be
Contact name: N A- ),55&") licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: g'7 7 ,5 is C',e'.a /41.91x7 jurisdiction in which work is being performed. If the
City /State /ZIP: 1 7 ps � , applicant is exempt from licensing, the following reasons
J apply: Q o
Phone: (53) pie p5 I Fax: : )6g`/ 9$y U 9 LL fe* 5 /42- - FPS / ems/ % / � T vra-7
E -mail: N 4 A, a `T/ yeehlci - d 4 a / cj c o is/ ' 6f P / Yj 4 y JOU �I)ft-L Ll,�p�/
CONTRACTOR -1-6.r
- 6 g0 - 7570! $
Business name: BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City /State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) / Fax: ( ) FLS plan review fee (if applicable):
CCB lie.: y`x g 56 �/ �' Total fees due upon application: _ I
, Amount received: l J
Authorized signature: ���e/J/�� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: /■ I `4 ti J��.p,,/ Date: 6 /7 g17 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02 /COM/WEB)
1
3
11,1 •
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 PemvtApp.doc 06/25/08
CITY OF TIGARD RECEIPT
, 1
fl; 13125 SW Hall Blvd., Tigard OR 97223
503 639,4171
TIGARD
72— L / 6/'E , : P7A D sw a - fit1
Receipt Number: 174344 - 07/14/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2009 -00116 Permit Fee - COM 245 - 0000 - 432000 $366.70
BUP2009 -00116 12% State Surcharge - Building 100- 0000 - 207020 $44.00
BUP2009 -00116 Plan Review 245 - 0000 - 433000 $238.36
BUP2009 -00116 Plan Review - Fire Life Safety 245 - 0000 - 433020 $146.68
' Total: $795.74
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Journal Entry 380 -12 -2009 DHOWSE 07/14/2009 $795.74
Payor: City of Tigard
Total Payments: $795.74
Balance Due: $0.00
Page 1 of 1
vi
i ! • City of Tigard
TIGARD Tidemark Journal Entry Request
This form is used to request a journal entry for Tidemark case fees to: 1) correct revenue accounts
of paid case fees, or 2) transfer fees between revenue accounts to pay case fees. Receipts and
documentation must be attached when applicable. All Tidemark journal entry requests must be
routed to the Tidemark System Administrator for processing. The Tidemark System
Administrator will route the request to Accounts Payable and a copy of the journal entry will be
returned to the Tidemark System Administrator to adjust or pay case fees.
DATE: 6/18/09 C /T7' 67-
REQUESTED BY: Debbie Adamski V f
CASE NO.: BUP2009 -00116
(
RECEIPT NO.: DA'Z'E:
EXPLANATION: Permit fees for Tigard Skate Park Restrooms
t; Posted�AccountDescri } r � tion< Posted
n ;.� Pos"t- "T � Acc o unt ; Descri tion Post Tod'`''
;'zv +a: 'a•s+p., ,: t. �'t,7sCa�;�,.> mss.. °a"i�z��z�"s wa. ;.�f�z; °:�.rr.�� "� ?� �5�'�:«, 3'''�3r ; ak.,, � .. , : v ;,s:s- z ^;
. a 'd
{Acca twherefeescurrentlyreside ).�'�;�� Am� q' (• S ccount f ee s are>. to� ' ans f erret i" to) � �� �� x� '* "��,` �� ��
7 a e k �AmOUnt
s * t '��., �d = a x s�,f r ,, '�. { y^fr: 'cn .�'�a �'`,
Exampl Q45 00(0 4 �' �4. Example 245 0000 - 432000 x .' .r ,
L D�, Permit Fee {r, = g sg E ,
270 - 640 - 757018 $795.74 245 - 0000 - 432000 $366.70 L-
Tigard Skate Park Restroom Permit Permit Fee - COM
100- 0000 - 207020 $44.00
vS 2 9,' ?571 1/4 12% State Surcharge - Building
245 - 0000 - 433000 $238.36
Plan Review
245 - 0000 - 433020 $146.68
Plan Review - Fire Life Safety
TOTAL: $795.74 TOTAL: $795.74
FORT' IDEIVIARK ;
Case Fees Adjusted: E #: °''G� j> - a0 Date: 41;' _ By:
1 \Buildin Refunds \J ournalEntr 09 /15/06