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Permit
I V O I D es Community Development TIGARD Request for Permit Action a/a2/// 'd TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff (check one) REFUND OR Name: Salem Sign Co Inc Corey Spady INVOICE TO: (Business or Individual) Mailing Address: 1825 Front St NE City/State /Zip: Salem, OR 97301 Phone No.: 503 - 371 -6362 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( • CANCEL PERMIT APPLICATION. ® REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM ' _►, T (do not cancel permit). Permit #: BUP2013- 00029 /S ! 3 /EL► 00087 Site Address or Parcel #: 13815 SW Pacific Hwy Project Name: H & R Block Subdivision Name: Lot #: EXPLANATION: These appear to be duplicates of BUP2013 -00014 (1/15) a - . • :: ' : j -. ". i r • � _ ._! _._ i i Signature: /L(�} l� �� Date: 2/11/13 S irley Treat Print Name: Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date / Rte to Bldg Admin: Date �® B Refund Processed: Date/✓ R" By < Invoice Processed: Date By Permit Canceled: Date �62j//,3 By ; arcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07 Building Permit Application v 0 2, , _. 1 ® a /` /! 0 Commercial FOR OFFICE USH ONLY RECEIVED Received City of Tigard Date/By: CF (( Permit No.: 63 _ ODD�7 2013 y IN ° 13125 SW Hall Blvd., Tigard, OR 97223 FEB 5 Plan Revie 0 Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit: ✓ �( j - TI G A 1 D Inspection Line: 503.639 D a t e Rea e" HI See Page 2 for Internet: www.tigard- or.gov CITY OF TIG ARD Notified /Method: f i � / r . Supplemental Information BUILDING DNISION ,� �� (( 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 [ 4ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2- family dwelling commercial /industrial Valuation: $ Number of bedrooms: V' ❑ Accessory building ❑ Multi- family I ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: jg�' c�i /< ' /)fit /,,,G ,_ New dwelling area: square feet I `V City/State /ZIP: 7 ( e) ©7 3 Garage /carport area: square feet '1j Suite/bldg. /apt. no.: Project name: /lia 13/06L 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 no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Valuation: $ / ° D Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State /ZIP: Existing: Phone: () Fax: ( ) New: f'APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* , ( (Please refer so fee schedule) Business name: Lc /✓j S -'' G ,c/ L � c / / Structural plan review fee (or deposit): Contact name: l R& y SGA-o , _ FLS plan review fee (if applicable): Address: /8 5 / �G ,,/ 6 � �` Total fees due upon application: City/State /ZIP: 5;4_ L�ry-1 d, 9 -73d / Phone: 3) 37/. X36 Z Fax:: ( ) _? • Q 'Q / Amount received: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: /, S� r •,�, 5 5 � /e i.-0 s/,..9 Cn t.r/( Commercial and residential prescriptive installation of ' l' CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: t -GZ7,✓r `$ �_% d) 4 j _ Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: tb' r „ f sr r. /E Solar Installation Specialty Code checklist. City/State /ZIP: s4 4c,}—%--1 6r J - '7 4/ / Permit fee (includes plan review $180.00 and administrative fees): Phone: (W ) 37/ - 6j6 a Fax: (T 3) 37/ . o 7 / State surcharge (12% of permit fee): $21.60 CCB lie.: 6 rj^2, q 7 j ?/V \ 1 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. re) Print name: ) 4 ✓ J P ,o ,44 Date: /• 30 . /3 * Fee methodology set by Tri- County Building Industry / Service Board. I: \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 46I3T(I 1 /02 /COM /WEB)