Permit (3) CITY OF TIGARD BUILDING PERMIT
N qCOMMUNITY DEVELOPMENT Permit#: BUP2019 00063
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/27/2019
TIGARD g Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: Installing a single,freestanding light pole and accompanying foundation. Electrical work will be applied for under a
separate permit by the electrical contractor.
Contractor: VISION POWER&LIGHT Owner: OUR REDEEMER LUTHERAN CHURCH
3809 W ST 13401 SW BENISH ST
WASHOUGAL,WA 98671 TIGARD, OR 97223
PHONE: 503-951-0415 PHONE:
FAX: 503-926-9384
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 11/27/2019 $70.22
Demolition
Occupancy Grp: U Occupancy Load: 12%State Surcharge-Building 11/27/2019 $8.43
Dwelling Units: 0 Plan Review 03/19/2019 $45.64
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 11/27/2019 $3.00
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $1,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $127.29
Required: Required Items and Reports(Conditions)
Fire Sprinkler: 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 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow - rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-01 .,90. Y• may obtain- ••y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: I ' Permittee Signature: ' { -
Call 503.639.4175 by 7:0-1—a-.-:forthe tavailable 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
1, g
'
Commercial .,',:- ,. ,,.t 3FOR OFFICE USE ONLY
Cit.11 . y of Tigard MAR 9 �0�9 IT
P'' ' 3
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-196e4 y` ;:::‘,ARDIlk ',i Related Permit:
TIGARD Inspection Line: 503-639-4175 B' o Di V a,iON D. ''
I a See Page 2 for
® Internet: www.ti and-or. ov • � ill Supplemental Inf
ormation
. ', _; , TYPE OF WO 17iri;r1 -47 o IJIRED DATA:I-ANp.2-K,,4 ILY DWELL I
®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 CONSTRUCTION44-4 work indicated on this application.
CI1-and 2-family dwelling XI Commercial/industrial Valuation: $
❑Accessory building ID Multi-family Number of bedrooms:
EI Master builder ill Other:
Number of bathrooms:
t FORMATION AND LOCATIONTotal number of floors:
Job site address: 13401 SW Benish Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: Light Pole Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW Walnut Street is the nearest cross street. Other structure area: square feet
REQUIRED DATA:COMMERq a.
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 2S 104AB, Tax Lot 4700 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
"a ' DESCRIPTION OF WORK work indicated on this as s lication.
f
Project is to construct a single, freestanding light pole and accompanying `"
foundation. Electrical work will be applied for under a separate permit by the Existing building area: square feet
electrical contractor hired to complete the work. New building area: square feet
4 , ® PROPERTY OWNER ' y C ;: 5
4.rM44.2„4.4,;-444, Number of stories:
Name: See deed on file or Minor Modification File for CUP2018-00008. Type of construction:
Address: Occupancy
City/State/ZIP:
Phone:( ) Fax:( )
❑ AP ICAN„,,,444:,t440342-7r ® C 441Aq_.:101?-10PA.,-.(:A P71;.'.1i:'.i:;'-','.---; BuILDING PERmIT FEEs*,-,,,,:, -:',,...,,,ill.1
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Business name: d 1.
Our' �' Pc'��r- )���e�� � urr 11,
Structural plan review fee(or deposit):
Contact name: Robert Peters
Address: /33'-2 / SO
Total fees due upon application:
City/State/ZIP: �Ga a d c7/ q7 3
Amount received:
Phone:C5-03) 3i1g S's 65 Fax::(----)--s
PANEL SYSTEM FE „14:
E-mail: y I c_t1?t'n f, G 'ti'1, •PHOT1
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4 ' CONTRACTOR -:, '''''',.:'—:':'V,1::::' ''il'f*,M1'” 14.„,,,, eprcmiaolureldresidential •tive •
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r Panel System.
Business name: 7 V t s 'UK pai,ti r t4- • • •• li
Address: 23W/c'c c6k, 3�7 / Solar tallation S.ecial Code checklist.
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City/State/ZIP: as 4 f o 1474— I 57 Permit fee(includes plan review $180.00
•
and administrative fees :
Phone:( ) Ao �� O Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: I Co)4.,57.,1, I 1 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
I within 180 days after it has been accepted as complete.
Print name: RE,L,64- /4111€74-,evs Date: 3/5/2018 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
114 " COMMUNITY DEVELOPMENT DEPARTMENT
I
T1caRD Building Permit Review — Commercial - No Land Use
Building Permit #: 6 te p,zo l q- O.ao3
Site Address: 310 t Da Bey iSh i-. Suite/Bldg#:
Project Name: Liq hi-- C>O to
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: St n (-(2-, free_ssi-o)o (IA-n (,t'C' co I2
Existing Business Activity: C.471 V rciti ) V 0 Cfr c4 n ,p
Proposed Business Activity: (`t. Ur01'1
Cv Verify site address/suite# exists and active in permit system.
0 River Terrace Neighborhood: ❑ Yes d No
7 Zoning: 4,
7 Permitted Use: ❑ Yes ❑ No ❑ Spec Space
7 Confirm no land use required.
❑ Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
Notes: ('tib«.9'er (j(Y)O 'ayi-hoc) ( 'a • -70-c- Oso
Approved by Planning: V CA/\/ . --- Date: 3/ I c1 ) 19
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: j //9/(,
Site Plans: #
Building Plans: #
Building Permit#: I Enter building permit#above.
Workflow Routing: I Planning iYi. Permit Coordinator ,.Building
Workflow Sign-off: I Sign-off for Planning(include notes from planning review)
Route Application Documents: ff Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: /14%f-Dix/hert/TA, Date: 3 //ei//
I:\Building\Forms\BldgPermitRvw_COM NoLandUse 060116.docx
1
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:
p1DC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes
Tigard Trans SDC: ❑ Yes Cd�N/A
Parks SDC: ❑ Yes Et N/A
tl�OK to Issue Permit
/2
Approved by Permit Coordinator: /4f Late: 3 1/7
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_070915.docx