Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 I
■
Request Permit Action /°/'y/'y
, ,,,Aim 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor RI City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) /,q
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
cn. CANC /VOID PERMIT APPLICATION.
RE ND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: PL}1c0/c9 --0Q 3 2.
Site Address or Parcel#: 714? £D ac A)7,er a il. 5-T
Project Name: 0cat S j3c)i3-A}C.CG55 ' Y' i9q- f,-,1 1.4, L07
Subdivision Name: Lot#:
EXPLANATION: Vo r PE.Q_H i -r A-S Pion ki. .I/•-Co Lo Pe_a s F N T-
L_DA5 j�pc..A-C-€a LA) rr7-1 4o2/£.1.10E.- PQvs Sc7— (eiuPaoi3-oo . 5-)
Signature: k ' /, ■1, ._ Date: /0 G/SL
Print Name: Egg(c. /V j c/
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b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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.
e) 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 2-4 weeks for processing refunds.
1-01Z CH I ICI; l Sl: ONI.1
Rte to S s Admin: Date/0 jraffilMIErgirra Rte to Bld:Admin: Date , AM B 4•9
Refund Processed: Date By ''." Invoice Processed: Date By
Permit Canceled: Datela//V/cf By i i, 'arcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012
Debbie Adamski
From: Debbie Adamski
To: 0111111wwifiximeten �D
Cc: Dianna Howse; Branden Taggart o
Subject: 7148 SW Gonzaga, Rogers Non-Accessory Parking Lot
Mark,
Prior to construction of The Adrienne on this lot, the property owner, Roy Rogers, had applied for and been approved to
create a stand-alone parking lot on this lot. We had reviewed and issued a site work permit but the site utility permit
was never paid for or picked up.
Now that the construction of The Adrienne is underway, I think the parking lot project is defunct. On the site work
permit no building inspections have been performed, but Ray has made 60 erosion control inspections. What should we
do with these permits?
SIT2012-00020 Site Work
PLM2012-00326 Site Utility
Debbie Adamski
It Senior Permit Technician
DIRECT 503 718-2450
rlG.hkr> Man. debbie@tigard-or.gov
wES www.tigard-or.gov
City of Tigard I CoMMt:NITY DEVEWPMFNT
13125 SW Hall Boulevard,Tigard,OR 97223
1
Plumbing Permit Application :�► 1 0 /0 /f /g i "
Site Utilities RECEN D FOR OFFICE l SF: ONIA
Received
City of Tigard Permit No.:
311
• 13125 SW Hall Blvd.,Tigard,OR 97 Th\I 2012 DateB : ��H�� LrlacYa-60 3
i. Phone: 503.718.2439 Fax: 503.598 9b0 O - Date/Byew Other Permit No.: p/r?pat-o10 0PO
T I G A R D Inspection Line: 503.639.4175 �/�T�`M Date Ready/By: N/ / Juris 1?1 See Page 2 for
Internet: www.tigard-or.gov Cj�l l 1�'r°0^ Notified/Method: f"� ,,/� 1�, Supplemental Information
TYPE OF W1 G i? 04yrry_d+1-ga Vr�C DULE
❑New construction ❑Demolition �/ For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ®Other:Parking Lot New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 lQt�'
1:1 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
Accessory building Multi-family SFR(3)bath 500.32
kl
CI Accessory Multi-famil
Each additional bath/kitchen 25.02 ,�
❑Master builder ®Other Site Work
Fire sprinkler( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: 1
Job site address:7148 SW Gonzaga St Catch basin or area drain 1 18.76 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Rogers Non-Accessory Park Manufactured home utilities 50.03 3
Cross street/directions to job site:Gonzaga and 72nd Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2 �t� �
Storm sewer(no.linear ft.:5.0) Page 2 6,2 597"
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:00800 Fixture or item:
Tax map/parcel no.:Was Co Tax Map 2S101 Backflow preventer l _ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Add approximately 4,800 sft of non-accessory parking Dishwasher 25.02
Landscaping and water quality facility Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Roy R.Rogers Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12700 SW 72'd Ave
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)620-2632 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Centrex Construction Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Steve Leasure
Roof drain(commercial) 12.51
Address:8250 SW Hunziker Rd Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)684-0443 Fax::(503)620-6692 Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Same as Applicant
Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 5i.30
Phone:( ) Fax:( ) Minimum permit fee: $72.50 $-7.2'50"'
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) l ,7ep
Authorized signature: TOTAL PERMIT FEE q11 c<
Print name:Steve Leasure Date:11-5-12 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)