Permit City of Tigard • C(MINIUNITY Dli\'ra.tn'\IEN'r DEP.\RTNIFMV ® 1
■ Request for Permit Action i1/y/r(e A&
13125 S\X' Hall Blvd. - Tigard, Oregon 97223 • 503-718-2439 • www.tigard-ongov
TO: CITY OF TIGARD
Building Division
13125 SWI Iall Wed.,]igard, OR 97223
Phone: 503-718-2439 I�az: 503-598-1960 1'igardBuildingPcrmits(tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor �:ity Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Ba.imsa nr Indi„Jn.,u
iAfailing :Address:
(:it}-/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERI\I1T :APP1.IGATION.
❑ REFL'ND PI:iRMIT FEES (attach copy of original receipt and provide explanation below).
F] INV'OICF, FOR FEES DLT' (attach case fee schedule and provide explanation below).
❑ REblOV'l i/RFPIu\CE CONIRM:TOR ON PI,:RI\ IT (do not cancel permit).
Permit #: 8a/0o20/5'--
Site :Address or Parcel#: / /V// SCe7
�Sft�9"�tff�
Subdivision Name: Lot #:
EXPLANATION: 7-Zi ,-7A/T”' L-E✓ E /0E72—
Cif-iI" .���✓�<T 1�t/ic,.,�/r!,/�r /�i/Sr°�c'Td.e_
Signature: G-�f T7TllTX� Date: /ZA /(o
Print Name: //ff-&/XZ7-
Round Polic)
1. The cin's Conumntite 1>evclopment Director,Budding Official or On I it nuts authorize the refund of`.
• .\nr fir which\raa crroncouslc paid or call mcl.
• Not mora th.m 80" of the application or plan rc'\lc'Rfee when an application is mlidrawo or can,, cd 6e Fore re<ic\c of,'t
Ira,Irm,"pcnd"I
• Aot mor,tkm 80",of tho application or ponnit hr for issued permitn prior to am inspection rcyuvate.
_. \II rotund,rcill b,morn,d to thu original pm cr in the form of a chuck ria I'S posed Icrcicc.
3, Plca,c Allo, 3-3 wcok, for 1)roc,ssin4 rotund royuut'
Route to Sus .-Admin: Dale By Route to Records: Date y /(o Br
Refund Processed: Date I Itn-oice Processed: Date Bc
Permit Canceled: Date j / 131arcel'1'a g.\dded: Date Bc
I 'Huildin)V I'nm...14,11..... Action_PI°i al 1-.0
Luilding-Permit AnwlicatioYEUEN EP V 0 I D 111y11(o 4y-
Commercial MAY 2 7 2015
City of Tigard Retetved� 7 u ao�s- T15
pp��1 Releiv : ✓ Perms. T/
13125 SW Hell Blvd.,Tigard,OR97� 1 %' OF 1 '��tfyRP Plan Review
B Phone: 503-718-2439 Fax: 503- �Q6Q� lf, yL /�Y, DzrNB : Related Permit.
Inspection Line: 503-6394175 Rtlnl\t,DI�fISN2� Date Ready/By:
Internet: vtvmA and-or. ov dfiedf.%Whod sre Pape2tar
g g � Sappkveaml lvfarmatien
TYPE OF WORK REQUIRED DATA:I-AND2-FAaIDLY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(marded 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.
❑ I-and 2-family dwelling Commerciallindustrial Valuation: S
❑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 / New dwelling area: square feet
City/StatNZIP: c[ Lf Garage/carport area: square feet
Suite/bldglapt.#: Project name: f}Sft/ f/Lri C Covered porch area square feet
Cross stmerldirections to job site: Deck arca: square feet
Other structure area: square Feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot k: Permit fees*are based on the value of the work performed.
'fax map/pamel Indicate the value(rounded to the rcatest dollar)of all
equipment,materials.labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on thi-�nlication.
/ Vaivati n �d ' v, S NJ/r!/ OF-��T FCS
Existing building area square feet
New building area: square feet
J3 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction: L'C.
Address: Occupancy groups:
City/State/ZIP: Existing: -
Phone:( _ Fax:( ) New:
APPLICANT ❑ CONTACT PERSON BUILDING PERBIIT FEES° //I.�v�""
m s4
Business name: r
Structural plan review fce(or deposit):
Contact name:
FTS plan review fee(if applicable):
Address:
Total fees due upon application-
City/State/ZIP: O / / U
Amount received: 3 / 6 '3
Phone:(5-4
E-mail- ` r PHOTOVOLTAIC SOLAR PANEL SYSFE8I FEES*
^CON'TRACIYIR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Submit tura(2)sets ofroof plan with connection details
- and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialp,SpecialCode checklist.
Cityt$tatelZlP: Permit fee(includes Ilan review $180.00
and administrative fees):
Phone:( ) Pas( ) State surcharge(12%of permit fee): $21.60
CCB Lic.: Total fee due upon appilalion: 5201.60
Authorized signature: `/ t` This permit application e:pirta If a permit is not obtained
within 180 days after it has been acmpted as complete.
Print name: C tKr; N.
Date: _ -� - - ' Fee methodology set by Tri-County Building industry
N. - � �' Servroe Board
7:1Building\Pcrmits\BUP_COM PemitApp.doc Rev.04212014 4404613T(11/02/COMIWEB)
• City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - With Land Use
Building Permit #: p(s 00 !S
Site Address: 1441 1 S W PCi 6 ti c (}w,, Suite/Bldg#:
Project Name: ASoi 190LAI-c_ 22StzivYzvt }
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: C1 (Ah59
Verify site address/suite #exists and active in permit system.
--B--River Terrace Plan District: ❑ Yes /In No
Land Use Case#: M M4 o I S - c m i-I
/11 Pl�an(s Match Approved Land Use:
/`J Site Plan ❑ Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
,JD Building Height: /Y Q 01,07),A-Maximum Height Actual Height
zz"Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business Lice se:
Exists: Yes ❑ No,applicant notified to obtain business license
u lic Facilities Improvement (PFI) Permit:
Required: ❑ Yes, applicant was notified -E]--No Applied For: ❑ Yes ❑ No, stop intake
Notes: J` �oZ/k.5- .Ql Y
—�—
Approved by Planning: rKL--9 r) 12 ct Gilc Date: -Sj 271I J
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: S/o2?A/S
Site Plans: # 3
Building Plans: # 3
Building Permit#: 42'Etter building permit#above.
Workflow Routing: .r Planning ❑ Engineering 1�Permit Coordinator `E-Building
Workflow Sign-offi $Sign-off for Planning(include notes from planning review)
Route Application Documents: :B-Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date:
1:19ui1dinglForm;\BldgPermitRvw_C0M_W ithLandUse_040115.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#: — �--
❑ Conditions "Met'prior to issuance of building pemnt
❑ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: PL W. Date: S z 7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
OK to Issue Permit -Z
�9 �G� eiLGa
Approved by Permit Coordinator: Date:
IABuildingToms\BldgPe nitRvw_COM_WithLwdUse_040115.docs