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Permit
Feb. 23. 2015 9: 22AM No. 0781 P. 3 �Cit o f Tigard • COMMUNITY DEVELOPMENT DEPARTMENT li RECEIVE '4 Request for Permit Action i ,, ;,\,t ,, 13125 SW Hall Blvd •Tigard,Oregon 97223 I. 503-718-2439 •ww .tigardFci t`*3 2015 til I U1 I'1GARD TO: CITY OF TIGARD BUILDING DIVISION • Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff Check(I)one vp 1 I REFUND OR Name: I i,5 1 qr v INVOICE TO: (Business or Individual) _ tµtit TL , La.. t o NS Mailing Address: �rd J O Al J E f ii.. City/State/Zip: M S LimA1 t t‘,t< a& al 3224:7 Phone No.: So 3 r - D-Ci 0 3 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): P 1 CANCEL/VOlT)PERMIT APPLICATION. al REFUND 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#: {-33.-- -?3ogD/4-D0l745 Site Address or Parcel#: 120 8 5 w HAIL ,Lift) - 1 w Project Name: ME U_wi S Subdivision Name: Ticer RI) Al It wI 'Fl?Att1Y Lot#: EXPLANATION: TD N , GU it Z Signature: Date: 2 - 1-3---15- . <it------ Print Name: 5- (Oil . R.c£und Policy f t The city's Community Development Director,Building Official or City Engineer may authori2e the refund of. • Any fee which was erroneously paid or collected- • Not snore than 80%of die application or plan review fee when an application is withdrawn or canceled before review effort A0 ata has been expended. ` t • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the foam of a check via US postal;cake. ad' / 01/ 01/3. Please allow 3-4 weeks for processing refund requests. /02 3, 702 - 7e, W _ y 2y 69) ,s _ I6 , e6 -7 , P / '/ q FOK OFFICE USE ONIX __ Route to S s Admin: Date . R [f !h Route to Records: Date ATMS B It1A Refund Processed: Date AVM. B .%/41 Invoice Processed: Date B Permit Canceled: Date Aq/R' B. 4:17A; Parcel Ta:Added: Date B I:\Building\Forms\RegPcamitAcdan_J' 4.doc • N TIGARD City of Tigard April 2, 2015 Stanley Security Attn: Steven Snyder 3810 SE Naef Rd Milwaukie, OR 97267 Re: Permit No. FPS2014-00175 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 12085 SW Hall Blvd, #130 Project Name: Arellanos Sports Bar Job No.: Refund Method: ® Check#216965 in the amount of$110.86. ❑ Credit card "return" receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, / I Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Requestfor Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Stanley Security DATE: 3/26/2015 Attn: Steven Snyder 3810 SE Naef Rd REQUESTED BY: Dianna Howse Milwaukie, OR 97267 TRANSACTION INFORMATION: Receipt#: 198137 Case#: FPS2014-00175 Date: 10/23/2014 Address/Parcel: 12085 SW Hall Blvd, #130 Pay Method: CreditCard Project Name: Arellanos Sports Bar EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Permit Fee 230-0000-43104 $98.98 12% State Surcharge 100-0000-24001 11.88 — TOTAL REFUND: $110.86 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional StaffZL If under under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: l//o2//S By: / I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT '"I a COMMUNITY DEVELOPMENT Permit#: FPS2014-00175 T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2014 Parcel: 2S 102AA00490 Jurisdiction: Tigard Site address: 12085 SW HALL BLVD 130 Project: Arellanos Sports Bar Subdivision: TIGARD HIGHWAY TRACTS Lot: 13 Project Description: Installaing(4)spoke detectors,(5)horn strobes and(1)pull station. Contractor: STANLEY SECURITY SOLUTIONS INC Owner: HALL STREET CROSSING LLC 15495 SW SEQUOIA PKWY STE 100 BY MR&MRS ROGER W TOM PORTLAND, OR 97224 8067 SW RIGERT COURT BEAVERTON, OR 97007 PHONE: 503-968-3353 PHONE: FAX: 503-968-3398 FEES Description Date Amount Specifics: Permit Fee-COM 10/23/2014 $123.72 12%State Surcharge-Building 10/23/2014 $14.85 Type of Use: COM Plan Review-Fire Life Safety-COM 10/23/2014 $49.49 Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 10/23/2014 $11.50 Occupancy Grp: A-2 Height: ft 11x17) Stories: 1 Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Standpipe Required: Hazard: Density: 0 Design Area: 0 K Factor: 0 Commercial Fire Alarm System: Fire Alarm Required: Yes Alarm Type: Automatic Pull Station Required: No Smoke Detectors Req: Yes Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $199.56 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $4,235.00 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: / er ltge Signature: Call 583.; 175 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 Fire Protection System FoR OFIicy l sI:()Nil Cl of Tigard Received `J g DateB : / /ln Permit No.: = .• 11111 I • 13125 SW Hall Blvd.,Tigard,O Plan Review ► Phone: 503.718.2439 Fax: 503 Date/B : < 1� Other Permit: t ao JY_ • 1� _• I lt, ,I:I1 Inspection Line: 503.639.4175 Date Ready/By: luri5: n See Page 2 for Internet: www.tigard-or.gov Notified/Method: ? • Supplemental Information MI i TYPE OF . ;' 1 MN &t REQUIRED DATA:1-AND 2-FAMILY DWELLING El New construction ;,�Ib. '�qr� Permit fees*are based on the value of the work performed. .,1 Al' '.9 Indicate the value(rounded to the nearest dollar)of all Addition/alteration/replacement C til er: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling NI Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 'd,0 g s _so 144 t( MoD. *3 New dwelling area: square feet City/State/ZIP: f l ia f J 0 k . 60070 Garage/carport area: square feet Suite/bldg./apt.no.: Project name: A t(1 let a 0'5 30/ Covered porch area square feet Cross street/diredions to job site: fro 111 ( 144 1 X31"d, 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. /Acs5oS5 l C_ FA- S-fsf-w, t,,,,rt h 2 .,r ,SA ov-CS, a Valuation: $ tf J5- t4-fler,iS{•►v its c3--A Q e Pd f l S-(0:60,‘'. Existing building area square feet New building area: square feet Eil PROPERTY OWNER I ❑ TENANT Number of stories: Name: ®(ha r 6 r C /(a rl C Type of construction: Address: f a 02'5- S(,,,) ti-411 d A % Occupancy groups: City/State/ZIP: Ti' p(cc 1 p2. 9 701° Existing: Phone:(R 7 f ) f0 c- 6 p,93"-- Fax:( ) New: tia APPLICANT ❑ CONTACT PERSON NOTICE Business name: S* ' e�/ s€Cur u-�.1 All contractors and subcontractors are required to be Contact name: ��p ,d I�� u q licensed with the Oregon Construction Contractors Board 1 under ORS 701 and may be required to be licensed in the Address: /45 c 50, Se 9 u o; . pK�,y a I 0 0 jurisdiction in which work is being performed.If the City/State/ZIP: -Vo rtl a'4 l O C q 7 Zz y applicant is exempt from licensing,the following reasons apply: Phone:(S03) 7 (,' - 33-7 7 �t Fax::(5'33 ) q 0?- 33`f 8 E-mail: dQ t7 I.ci . /0,,,,,,� 3 Q J 6 0 /`)C . c 0.vm CONTRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule1 Business name: c itd I SPCrtU Permit fee: Address: f 5-q qS ,A) 7epU O /a (c""y 0 ,0 a State surcharge(12%of permit fee): City/State/ZIP: Po l-r(a-& icoQ - 9 722 y FLS plan review(40%ofpermit fee): Phone:(SO/ ) 96,7 - 5 3 1-7 Fax:(CO3 ) 9 6 s' c 1�j 3 7 7 ! (Due upon application submittal.) . CCB lic.: "rf: /6[57,27 Total permit fees: 1 . Cxo Authorized signature: Amount received: ` This permit application expires if a permit is not obtained Print name: -Da V 1 4 y o (,f J C� Date:r© z3— 2 0/? * within 1180 days after it has been accepted as complete. / Fee methodology set by Tri-County Building Industry Service Board - I:\Building\Permits\FPS-PermitApp_071514.doc 440-46I3T(1 l/02/COM/WEB) 1 - v City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information Describe work to be done: 1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices: ❑ New system Number of sprinkler heads: Number of alarm devices: ❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and Alteration (3)copies of sketch showing area (3)copies of sketch showing area to existing of work within building structure of work within building structure system ❑ 11+heads: Plan review required and ❑ 6+ devices: Plan review required and (3)sets of plans. (3) sets of plans. Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area _ K. Factor Sprinkler Project Valuation: I $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: I $ C.) Fire Alarm Submittal shall Battery Calculations Yes include: Individual Component ❑ Yes Cut Shccts Fire Alarm Project Valuation: I $ 2.37 D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A,B &C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12%of permit fee): $ • FLS Plan Review(40% of permit fee): $ TOTAL: $ I:\Building\Permits\FPS_PennitApp_071514.doc 2