Permit Support Document vfl ' n
pr,
Community Development
TIGARD
Request for Permit Action
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 n Applicant ❑ Contractor [ 'City Staff
(check one)
REFUND OR Name: )-/J
INVOICE TO: (Business or Individual) 1 leg,�15- /!. 0i-6t-E A.ogoG R-rr s /tom
Mailing Address: B7 410 aW bdei..A 45 Ti2¢E.r-
�/g
City/State/Zip: 'e1,/f,27 / 0a_ r'7,2 3
PhoneNo.: 57)5- 639 - 3c153
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt,if available).
ri-
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit#: —7,73La c9.0 i0 DO 147
Site Address or Parcel #: 7 3 a 5u3 bd.() t t r,1S `aR' .51- too
Project Name: M LA eat /IJ(._
Subdivision Name: Lot #:
EXPLANATION: pcJZ A-Ptpl.t c_..et}NT '77\61)3 ctG} I..)Ct A.Uf D t ✓p,-0 I tiU`t t r
P 0 ( L 14AL) 61 P-r -tb 1 &Jo 1 -t t if c Et ✓£b Orr h ti ke/
i kJ 00, e I Q • +. i.01 s.i-J i' - 5 , Pia MArzk,
Signature: �, ! _ v -..ILA--.A:i_ Date: 7(4)if()
Print Name: 1 -.Yeraj6 is (>Cµ6(/.
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b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 1-2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date 7(. /1J B� Rte to Bldg_1dlmin: Date Q !MAW
Refund Processed: Date B■ Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt# Date Method Amount$
I:\Building\Forms\RegPernutAction.doc Rev 07/26/07
Gym
Building Permit Application '\' X E 77 ■1 **-
Commercial RECEIVED FOR OFFICE USE ON I 1
CI of Ti and Received Permit No..
`.1 g DateB : /0 `I • 010-e:;01‘17
14 II • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 N 2 9 (0 1 0 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: kris. ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF VYO RK REQUIRED DATA:1-AND 2-FAMILY DWELLING
LI New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ❑Commercial/industrial Valuation: S
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 842_SA),S'LD/5'HS 5 T New dwelling area: square feet
City/State/ZIP: 77 ,4z42 Garage/carport area: square feet
Suite/bldg./apt.no.: COQ I Project name://4/$4., 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.
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.
�✓��� -� /O�- ,/y�/��✓���NTS Valuation: S 7ero,
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: /2/—,4•/L _Z"4fL ' Type of construction:
Address: e975/D S4 Sci05 /A'Y S/_,
Occupancy groups:
City/State/ZIP: T` Existing:
Phone:(472 ) l0 3,1"• 3ys3 Fax:( ) X39/Z3Z New:
❑.APPLICANT ❑ CONTACT PE ON NOTICE
Business name: C� All contractors and subcontractors are required to be
Contact name: � � licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
CONTRACTOR
Business name: 1 14/frkf,44.- ‘26D/40170,11;14.)T— BUILDING PERMIT FEES*
Address: 03/11 -7>?, EE/ 3 Meese refer to fee seised:del
City/State/ZIP: pTL7 Q2 Structural plan review fee(or deposit):
Phone:( ) g. 9/0 y I Fax:( ) FLS plan review fee(if applicable):
CCB lic.: /1Pj
7/i4��o Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: / G Date: within 180 days after it has been accepted as complete.
`L/ /! f/ G Z9 /a * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building • rmits\BUP-C• '•ermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
1
4
'Pi ■ III
Building Division
Accessibility: Barrier Removal Improvement Plan
I I( ARl)
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\Pernits\BUP-COM PermitApp.doc 06/25/08
Building Division
Plan Submittal Requirements
r c r A R Commercial& Multi-Family- New,Additions or Alterations
1. SITE PLAN (fully dimensional, drawn to scale) labeled with:
A. ❑ map& tax lot# ❑ project name ❑ site address ❑ suite number
El zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit-based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
I:\Building\Permits\BUP-COM PermitApp.doc 06/25/08
111111 ■
Building Division
Plan Submittal Requirement Matrix
I WARD D Commercial& Multi-Family- New,Additions or Alterations
Type of Submittal # of Plans
(Includes new,additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 2
Fire Protection System 2
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,Washington
County, and Tualatin Valley Fire &Rescue)
I:\Building\Permits\BUP-COM PermitApp.doc 06/25/08