Permit CITY OF TIGARD BUILDING PERMIT
:: COMMUNITY DEVELOPMENT Permit #: BUP2013 -00197
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01 /2013
Parcel: 2S 113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: CCK Restaurants LLC Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: TI
Contractor: PACIFIC REALTY ASSOCIATES LP Owner: PACIFIC REALTY ASSOCIATES LP
15350 SW SEQUOIA PKWY #300 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300 PHONE:
FAX: 503 - 624 -7755
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review, COM TI - Ping 08/01/2013 $70.00
Occupancy Grp: B Occupancy Load: 65 DC Provision Review, COM TI - LRP 08/01/2013 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 08/01/2013 $286.64
Demolition
Stories: 1 Height: 0 ft 12% State Surcharge - Building 08/01/2013 $34.40
Bedrooms: 0 Bathrooms: 0 Plan Review 08/01/2013 $186.32
Value: $13,700 Plan Review - Fire Life Safety 08/01/2013 $114.66
Info Process /Archiving - Sm $0.50 (up to 08/01/2013 $2.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $704.02
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes 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 da of i ,nce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon U i No "ratio enter. Those rules are set forth in OAR
952- 001 -0010 g 1952- 001 -0090. You may obtain a copy of the rules or direct questions to OUN • •y • = ling 503.2 .1�: or 1.800.332.2344.
Issued By: Q Permittee Signature '
Call 503.639.4175 by 7:00 a.m. for the next available i spection!'
This permit card shall be kept in a conspicuous place on the job site u II comp)- • n of the project.
Approved plans are required on the job site at the time of eac inspection.
Building Permit Application
Commercial R OE y ED FOR OFFICE USE O \L1
City of Tigard j 9' Received. , ff Permit No.: , o... L4 �r 5,0019
• 13125 SW Hall Blvd., Tigard, OR 9720 G 1 20 Plan Revie jirti Other Permit:
C Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : v1 I'
T 1 G n I . Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/13y: Lurie: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method Supplemental Information
B UILDING DIVISION
a itZd�1siiT;', \ 5 1'�t I 1, 1 i :d) a o_onYp,f ,. Ii).G.Vul(i) -In V,':I kIiS'
,
❑ N ew construction ❑ Demolition
Permit fees' are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
►'� Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
— _ � wo indicated on this application.
6 s i t to• oly y a u , (CICIRK� - r) �e;(cirf_O
❑ 1- and 2- family dwelling prComercialfmdustrial
Valuation: $
m
1:1 Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
f _
' i ) : ' C � 11,I a )1 1 :6i i 0 ■ s' 11 (51;1 AV Ii) i t olc, \ I"RONnt ) Total number of floors:
Job site address: I l 1 ens SkZ -2Y !'1 New dwelling area: square feet
City/ State/ZIP: fl -o I (9 6t 7LZ1-i Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: (f Q_Q,,i, IL _ A (0, J Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
' Other structure area: square feet
H (.p.I 11 alDilYUJr\4(c,(ol�Il� i ;Ycl 14,(o�y' CI 131C1�� ,J
Subdivision: I Lot no.: Permit fees' are based on the value of the work performed.
Tax map/parcel Indicate the value (roinded to the nearest dollar) of all
no.: equipment, materials, labor, overhead, and the profit for the
i L I0 ?b:i 1l - I I ;.'+ (o] \'' g t: .. 1 work indicated on this :,. • lication.
��^^ � _ ..:
k 1Ik�JV % % C I 1 : 1 V\ A.r tb TY't7� Vin Skailrock Valuation $ 13 Q
t Existing building area square feet
New building area: square feet
. _ 1-71 :6 3(1)-• .tiLRe (Alp -,'; 1 31-•
, ' � ; ) rt 1; : Number of stories:
Name: #AC—IT V C2.1— Type of construction:
Address: I S S1O V O tG. 9 1 Occupancy groups:
City/ State/ZIP: eAr'rta 4 ei e q-722)-1- Existing:
Phone: .,„; ( _&220.0 Fax: A ) , -77SS New:
v .
_ _ _ name: Structural plan review
va L.�) 1aE1Zld�uo �C�,,CeUh 1F_ (�li 1 aJ,(ol�� Iadt Lf 1
Business name: � __ , (L f�3 �. a 1/�it� w � .. _ _- . . _
1n p fee (or deposit):
Contact name: elan C ol V t Y �,
FLS plan review fee (if applicable):
Address:
Total fees due upon application:
City/State/ZIP:
Phone: O - ;- 1044 I Fax:: ( ) ., Amount received
) t (O,I iCRl IY„::((E wii) Lr \l l Ii(.\ \16) . ,$ '_tit!) ifil∎ i I ■t')• i
E-mail: 'S r • . I L A " a- • V1A
Co)�` — 1 Commercial and residential prescriptive installation of
tc t'1' ( c 1 t(o1,3 1 roof -top mounted Photovoltaic Solar Panel System.
Submit two (2) sets of roof plan with connection details
Business name: pAc.:Ty• v Si and fire department access, along with the 2010 Oregon
Address: Solar Installation Srecial Code checklist.
City/ State/ZIP: Permit fee (includes plan review $180.00
and administrative fees :
Phone: ( ) I Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB tic.: Total fee due upon application: $201.60
Authorized signature: I Date: ;� This permit application expires if a pe rmit is not obtained
within 180 days after it has been accepted as complete.
Print name: �
` * Fee methodology set by Tri -County Building Industry
Service Board
I:\Building\Permits\BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11 /02/COM/WEB)
C Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Project Description: 1
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work *: (T Occupancy Group: Type of Construction:
Type of Use * *: - IA Occupancy Load: ( Oregon Specialty Code: "zo j cp
SPECIFICS
Number of Stories: Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS •
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: ( t 2 e % 5 Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor:
Total Project Valuation: $ 3?C FEES DUE
$ 70.cO DC Prov Rvw, COM TI — Ping
$ • , DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI (effective 7/1/2013) $ a ' Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ , ' 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ ( g.& Plan Review, Structural
$5,000 - $74,999 $70.00 $10.00 $ l , Plan Review, Fire Life Safety
$75,000 - $149,999 $174.00 $26.00 $ Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $278.00 $41.00 $ '2L2 Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc. Admin Fee
$ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ 10 TOTAL FEES DUE
"TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
**CLASS OF WORK ACS = accessory; ADD = addition; ADU = accessory dwelling unit; ALT = alteration; DEM = demo; NEW = new;
OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies).
I: \ Building \ Forms \OTC- BUI'.docx 07/01/2013
Building Division
Development Code Provision Review
T G A R D Residential Projects
Building Permit No.: 1 ? J — DO 197
Project /Subdivision Name: C C I h i
� uc�1li -•� Lot #:
Site Address: /6 l e o 5 'o 72- ``-t V --
CWS Service Provider Letter:
Required: Yes ❑ No ❑
Received: Yes ❑ No ❑
Plans Routed: l
Original Plan Submittal Date: g /11 3 Routed By:
1St Revision Submittal Date: ❑ Site Plan Only Routed By:
2n Revision Submittal Date: ❑ Site Plan Only Routed By:
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approv • .
Planning Review (contact /dc,: _ :__: ' ' at (503) 718- 2 - 1 1 3 W or • @tigard-
or.gov) [ i
Land Use Case No. /'
Zoning I — 1
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height: Actual Building Height
Oil/ 0 Visual Clearance
❑ Easements
❑ Sensitive Lands Type:
/ ❑ Street Trees
r ❑ Protected Trees
Notes: I.'1 tC� ri), I T
( /10 rGz-Ll(J 5c_ ASS. u-ei
i
Original Plan: Approve Not Approved ❑ Date: 8' _'_ / 3
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
• Page 1 of 2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at (503) 718 -2426 or albert@tigard-or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2
I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13