Permit 111 V
i
TIGARD
City of Tigard
April 3, 2020
OFNHP Local 5017
1500 NE Irving St, Suite 575
Portland, OR 97232
Re: Permit No. BUP2019-00320
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 11560 SW 67th Ave, 100
Project Name: OFNHP
Job No.: N/A
Refund: ® Check#235146 in the amount of$2,365.14.
❑ Credit card "return" receipt in the amount of$
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$
Comments: Scope of work was reduced resuling in a reduction of permit fees. Refund
difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Ornelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
III0 ' City of Tigard
I.i G Accela Refund Request
ARD
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for 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 OFNHP Local 5017 DATE: 3/30/2020
TO:
1500 NE Irving Street, Suite 575
Portland, OR 97232 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: Various Case#: BUP2019-00320
Date: Various Address/Parcel: 11560 SW 67th Ave, 100
Pay Method: Check Project Name: OFNHP
EXPLANATION: Reduced project valuation from$140,000 to $20,000 resulted in an overpayment of
$2,365.14. Refund 100%of the difference.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Cash Over 100-0000-48001 $2,365.14
TOTAL REFUND: $2,365.14
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff S' = ' j L_
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: (( 3 791 By: Cy
1:\Building\Refunds\RefundRequest.doc x 09/01/2010
Dianna Ornelas
From: Dianna Ornelas
Sent: Monday, March 30, 2020 6:39 PM
To: Kat Suttles
Cc: Amy Lawson
Subject: Refund Request - OFNHP
Attachments: OFNHP_033020.docx; BUP2019-00320_428028_2.pdf
Good evening Kat,
Please see attached refund request that can hopefully go out this week. Please add this refund check to the batch for
this week so that I can pick up the checks on Thursday night and send out in the mail with the refund letters.
Please let this email serve as my signature of approval on the attached refund request form.
Thank you!
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: OFNHP
Site Address: 11560 SW 67TH AVE 100
Receipt Number: 436236 - 09/03/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00320 $-2,365.14
Total: $-2,365.14
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 235146 DHOWSE 09/03/2021 $-2,365.14
Payor: OFNHP Local 5017
Total Payments: $-2,365.14
Balance Due: $2,365.14
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI,GAP.O
Project Name: OFNHP y
Site Address: 11560 SW 67TH AVE 100 ! 7-145 6-41/
Receipt Number: 428028 - 02/03/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00320 DC Provision Review, COM TI-Ping 100-0000-43112 $91.14
BUP2019-00320 Info Process/Archiving-Lg $2.00(over 230-0000-43135 $20.00
11x17)
BUP2019-00320 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $11.00
11x17)
BUP2019-00320 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $14.00
11x17)
BUP2019-00320 Cash Over 100-0000-48001 $2,365.14 de—
Total: $2,501.28
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 8811 BTAGGART 02/03/2020 $2,501.28
Payor: Oregon Federation of Nurses&Health Professionals, Local#5017
Total Payments: $2,501.28
Balance Due: $0.00
Page 1 of 1
1,11 CITY OF TIGARD RECEIPT
g; !, 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: OFNHP
Site Address: 11560 SW 67TH AVE 100
Receipt Number: 428028 - 02/03/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2019-00320 Permit Fee-Additions,Alterations, 230-0000-43104 $1,347.55
Demolition
BUP2019-00320 12%State Surcharge-Building 100-0000-24001 $161.71
BUP2019-00320 DC Provision Review, COM TI-Ping 100-0000-43112 $254.00
BUP2019-00320 Plan Review-Fire Life Safety 230-0000-43108 $539.02
BUP2019-00320 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $20.00
11x17)
BUP2019-00320 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $11.00
11x17)
BUP2019-00320 Metro Const. Excise Tax 230-0000-24010 $168.00
Total: $2,501.28
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 8811 BTAGGART 02/03/2020 $2,501.28
Payor: Oregon Federation of Nurses& Health Professionals, Local#5017
Total Payments: $2,501.28
Balance Due: $0.00
Page 1 of 1
Branden Taggart
From: Dianna Ornelas
Sent: Tuesday, March 17, 2020 4:10 PM
To: Branden Taggart
Cc: #Building Permit Technicians
Subject: RE: Permit Refund
Branden,
Please print this email and put a copy with the revised plans on my desk.
Thanks!
Dianna
From: Keely Glassley<kglassley@ofnhp.org>
Sent:Tuesday, March 17, 2020 2:15 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Permit Refund
Caution!This message was sent from outside your organization.
Brandon,
This will confirm our conversation that OFNHP is requesting a permit refund due to the new scope of work which
reduced to $20,000.
BUP 2019-00320
11560 SW 67th Avenue, Suite 200
Tigard, OR 97223
Please let me know if you need any additional information.
The check should be made payable to:
OFNHP Local 5017
1500 NE Irving Street, Suite 575
Portland, OR 97232
Thank you—Keely
Keely Glassley
Sr. Executive Assistant
Oregon Federation of Nurses &
Health Professionals (OFNHP)
Cell: 503-875-6244
kglassleyPofnhp.org
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
1
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-moils are retained
by the City uf Tigard inoomp|ianoowidlthmOregnnAdminiebativeRu|eu ^CityGenera| RaonndaRetentionSohedu|o,^
'
2
FOR OFFICE USE ONLY— SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
111 Transmittal Letter
l G A R l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Ci+lt o TerraDATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Mt1,r,�, �Gt,k MAR 2 2020
®® CITY OF f IGARD
COMPANY: C�a� BUILDING GJVIS n
ir
PHONE: (SO 3) �.,2-6— d;$S BY
RE: 11 S6o IN) 6 H1. Ave_ ico E U?a_o 19--oo 3
(Site Address)
(Permit Number)
OF A
(Project name or subdivision name and lot number) /i
ATTACHED ARE THE FOLLOWING IT D t
Copies: Description: ti Copies: Description:
Additional set(s) of plans. 1 kA)11) X Revisions: ? ►o n a t S Cop,
Cross section(s)and details. 3'\ Wall bracing and/or late2l analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: (1 K %) ti 4 re(,j-G . ((i) -,t,S n-ew a et-Sc-Lueric -
r . :`211: •I _g /5.0er/ iya, I'D a. a-t) -cam
FOR OFFICE USE ONLY
Routed to Pe , t Technician: Date: Initials:MA V
Fees Due: / Yes C No Fee Description: Amount Due:
7 4 . Sti.ur5 (ALcO fit) $
APtL p;.,/ p&v/a-k ✓ $ y5'"
$
$ 59 -
ecial
nstructions:
Reprint Permit (per PE): ❑ Yes �No ❑ Done
Applicant Notified: � Date: 3/$0-1, Initia .
1:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
Branden Taggart
From: Branden Taggart
Sent: Friday, March 27, 2020 8:48 AM
To: Dianna Ornelas
Cc: #Building Permit Technicians
Subject: RE: Permit Refund - BUP2019-00320 - OFNHP
Attachments: Branden Taggart2.vcf
Hi Dianna,
Good morning. I just realized that I got busy and did not place this permit on your desk yet for the valuation change. I
pulled it out of the scanning area today, and it is now on your desk with a copy of this conversation. I will mention to
the customer that a refund will be received within 4-6 weeks.
Thanks,
IIIBranden Taggart
City of Tigard
■ Senior Permit Technician
TIGARD Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(503)71B-2449
brandent@tigard-or.gau
From: Branden Taggart
Sent:Tuesday, March 17, 2020 4:04 PM
To: Dianna Ornelas <Dianna@tigard-or.gov>
Cc: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; Tom Hochstatter<TomH@tigard-or.gov>
Subject: RE: Permit Refund - BUP2019-00320-OFNHP
I issued the revision to the customer over the counter yesterday. I noticed the$20,000.00 valuation on the transmittal
letter, and the customer mentioned that the scope of work was reduced. Mark overlooked it, and the contractor didn't
want to deal with the situation at the counter, and said that they will have the project manager/applicant deal with the
fee reduction—all during our transition period yesterday.
I will place the plans on your desk.
Thanks,
1
Branden Taggart
-- City of Tigard
,`. Senior Permit Technician
ItCARD Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(503)718-2449
brandent o tigard-or.gov
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent:Tuesday, March 17, 2020 3:44 PM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>;Tom Hochstatter<TomH@tigard-or.gov>
Subject: RE: Permit Refund - BUP2019-00320-OFNHP
One other thing, after Tom reviews the revised plans, please put this one on my desk to process the reduced valuation
and refund.
Thank you.
Dianna
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent:Tuesday, March 17, 2020 3:37 PM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Permit Refund - BUP2019-00320-OFNHP
Importance: High
Hi Branden,
Since I don't know the content of your phone customer, here is what we require.
Their email requesting us to reduce the valuation is not sufficient. For a reduction in valuation, we require the applicant
to submit a transmittal letter explaining what was removed from the plans and the amount of the new project valuation,
along with (3) sets of plans showing the actual changes. It is not necessary for them to fill out a request for permit
action form to request the refund.
Please contact the customer to let them know.
Thank you.
Dianna
From: Keely Glassley<kglassley@ofnhp.org>
Sent:Tuesday, March 17, 2020 2:15 PM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Permit Refund
Caution!This message was sent from outside your organization.
Brandon,
2
This will confirm our conversation that OFNHPis requesting apennitrefundduetothenewscopeofvvorkvvhich
reduced tn $ZO,O00.
BUP2O19-0O320
11S6OSVV57m Avenue, Suite 2O0
Tigard, OR 97223
Please let me know if you need any additional information.
The check should be made payable to:
OFNHP Local SO17
1S00NEIrving Street, Suite57S
Portland, OR 97332
Thankyou—Kee|y
KoolvGlnoa}ey
Sr. Executive Assistant
Oregon Federation nf Nurses 8z
Health Professionals (O}Nf{P)
Cell: 503-875-0244
kv}nuo}ey0a nfuhp.org
�
DISCLAIMER: E'mai|s sent or received by City of Tigard employees are subject to public record laws. If requested, e-mailmay be disclosed to another party unless exempt from disclosure under{}regon Pub|iu R��ond� Lavv E'mai|n are ~tained
by the City of Tigard in compliance with the Oregon Administrative Rules ''City General Records Retention Schedule."'
3
,
FOR OFFICE USE ONLY- SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
Tit:;A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
il
TO: C.446, o t 0 DATE RECEIVED:
DEPT: BUILDING DIVISION
/ RECEIVED
FROM: l'A NALL MAR 2 2020
COMPANY: f' �� CITY OF "f ICARD
BUILDING C,IUIS l
PHONE: (CO3) �,2(- 11-6 BV
RE: 115-6o h1 EVP 1 —003�
5 6�-�, �v� 1G10 �-o q
(Site Address) (Permit Number)
oPNfee
(Project name or subdivision name and lot number) /
/
ATTACHED ARE THE FOLLOWING IT .
Copies: Description: Copies: Description:
Additional set(s) of plans. X Revisions: k o n a t c co t.
Cross section(s) and details. ' Wall bracingand/or la r 1 1� tea analyses.
Floor/roof framing. 1 Basement and retaining walls.
Beam calculations. // Engineer's calculations.
Other(explain): /,r
REMARKS: (1 \ 1A(lA, t i 4 re1 - 4 (`) ln.ct.--, dc.,.,16.•3 , K-ew e itSt-wcy-6.-
FOR OFFICE USE ONLY
Routed to Pe it Technician: Date: Initials:MA V
Fees Due: Yes ❑ No Fee Description: Amount Due:
7 LA . S,i try (Aami t') $ /g o
Avg p izkv,3-4.4, $ yS
$
$ 5'9
ecial
nstructions: •
Reprint Permit(per PE): ❑ Yes o ❑ Done
Applicant Notified: , ,- Date: 3/ic/ Initials-.At
t:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
CITY OF TIGARD BUILDING PERMIT
" ■ .p COMMUNITY DEVELOPMENTIf
Permit#: BUP2019-00320
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 a'O vPO Date Issued: 02/05l2020
Parcel: 1 S136DD00200
Jurisdiction: Tigard
Site address: 11560 SW 67TH AVE 100
Project: OFNHP Subdivision: WEST PORTLAND HEIGHTS Lot: 8
Project Description: Interior alterations to accommodate new owner/tenant on first and third floors,suites 100 and 333. 2/28/2020:
REPRINT permit to correct suite address.
Contractor: COOPER CONSTRUCTION CO Owner: 11560 SW 67TH LLC
PO BOX 2020 1500 NE IRVING ST STE 575
CLACKAMAS, OR 97015 PORTLAND, OR 97232
PHONE: 503-232-3121 PHONE: 503-226-1285
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 02/03/2020 $1,347.55
Demolition
Occupancy Grp: B Occupancy Load: 146 12%State Surcharge-Building 02/03/2020 $161.71
Dwelling Units: 0 Plan Review 11/26/2019 $875.91
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 02/03/2020 $254.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 02/03/2020 $539.02
Value: $140,000 Info Process/Archiving-Lg$2.00(over 02/03/2020 $20.00
11x17)
Info Process/Archiving-Sm$0.50(up to 02/03/2020 $11.00
Floor Areas: 11x17)
Metro Const. Excise Tax 02/03/2020 $168.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,377.19
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / �� / e,�-
f � (Y c
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial x t.._,... ; M , 1 t1R t,Fl It i t Sl 0.1 ,
City of Tigard 2 o�eiv� 11 llg k' i y—IXJ
i q 13125 SW Ball Blvd.,Tigard,OR 97223 NI1, p 6J Itr Plan Review 1 m
Phone: 503-718-2439 Fax: 503-598-1960 Date/By: 1l. • J Related Permit:
Ins ection Line: 503-639-4175 t' Date Ready/By: t>ai�: I BI See Page 2 for
IIG,IRU p ) p
Internet: www.tigard-or.gov *� „;�, Notified/Method:`/./L !' /a� Supplemental Information
TYPE OF WOZ{i{, IIDA'PA 1-$o2-FAMILYAVVf,'kd zrc
❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCIION .
work indicated on this application
❑ 1-and 2-family dwelling Valuation: $
®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11560 SW 67TH AVE New dwelling area: square feet
City/State/ZIP: TIGARD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: " I Project name: OFNHP Covered porch area: square feet
Cross street/directions to job site: SW BAYLOR ST./ SW 67th AVE. Deck area: square feet
Other structure area: square feet
REQUIRED DATA,COMMERCIAL-USE CHECKLIST
Subdivision: l Lot#: 00200 Permit fees*are based on the value of the work performed.
Tax map/parcel#: 15136 D D 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.
INTERIOR Al TFRATIONS TO THE EXISTING BIJI PING TO ACCOMMODATE NEW Valuation: $ 140,000
OWNER/TENANT ON FIRST ANDTHIRI) LOORS. Existing building area: 14,586 square feet
EXISTING SECOND FLOOR TENANTS TO REMAIN (NO WORK). NO EXTERIOR WORK. New building area: N/A square feet
0 PROPERTY OWNER 0 TENANT Number of stories: 3
Name: Type of construction: V-B
Address: Occupancy groups:
City/State/ZIP: Existing:8
Phone:( ) Fax:( ) New: B&A-3
® APPLICANT 55 CONTACT PERSON BUILDING PERMIT FEES*
Business name: CIDA (Please reereefeeschu6le)
Structural plan review fee(or deposit):
Contact name: MYA PALUCH
Address: 15895 SW 72ND AVE,SUITE 200 FLS plan review fee(if applicable):
City/State/ZIP:PORTLAND,OR 97224 Total fees due upon application:
Amount received:
Phone:( 503)226.1285 Fax::( 503)226.1670
E-mail:MYAP @ CI DAI NC.CO M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
• .. Commercial and residential prescriptive installation of
. ►iVxavaLI C1H' roof-top mounted PhotoVoltaic Solar Panel System.
Business name: T n v Le z,P�2 LO vS r . co Submit two(2)sets of roof plan with connection details
1 and fire department access,along with the 2010 Oregon
Address: P.0, 2 Zo 2.G' Solar Installation Specialty Code checklist.
City/State/ZIP: 0_, ,nqS) 02- 6.3 7o ( 5 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(CO ) 7S o- Z L 1 6 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 7_0'7 S Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: MYA PALUC Date:11/21/19 • Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP_COM_ tApp.doc Rev.04/21/2014 440-4613T(ll/02/COM/WEB)
CITY OF TIGARD BUILDING PERMIT
1 111: COMMUNITY DEVELOPMENT Permit#: BUP2019-00320
Date Issued: 02/05/2020
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DD00200
Jurisdiction: Tigard
Site address: 11560 SW 67TH AVE 200
Project: OFNHP Subdivision: WEST PORTLAND HEIGHTS Lot: 8
Project Description: Interior alterations to accommodate new owner/tenant on first and third floors.
Contractor: COOPER CONSTRUCTION CO Owner: 11560 SW 67TH LLC
PO BOX 2020 1500 NE IRVING ST STE 575
CLACKAMAS, OR 97015 PORTLAND, OR 97232
PHONE: 503-232-3121 PHONE: 503-226-1285
FAX:
FEES
Specifics:
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 02/03/2020 $1,347.55
Demolition
Occupancy Grp: B Occupancy Load: 146 12%State Surcharge-Building 02/03/2020 $161.71
Dwelling Units: 0 Plan Review 11/26/2019 $875.91
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 02/03/2020 $254.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 02/03/2020 $539.02 I
Value: $140,000 Info Process/Archiving-Lg$2.00(over 02/03/2020 $20.00
11x17)
Info Process/Archiving-Sm$0.50(up to 02/03/2020 $11.00
Floor Areas: 11x17)
Metro Const.Excise Tax 02/03/2020 $168.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,377.19
Required: Required Items and Reports(Conditions)
1 Special Inspection(see plans)
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 the rules adopted by the Oregon Utility Notification Center. ose 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 c ' 03.232.1987 1 00.332.2344.
Issued By: / Permittee Signature:
a 503.639.4175 by 7:00 a.m.for the next available inspection d te.
This permit card shall be kept in a conspicuous place on the job site until comp) ti91 of the project.
Approved plans are required on the job site at the time of each inspklttion.
Building Permit Application
Commercial , FOR OFFICE USE ONLY
Received ) �j_
City of Tigard Date/By: t( �� P •����' �/ 06L
a 13125 SW Hall Blvd.,Tigard,OR 97223 N V 2 ✓n q Plan Review
C Phone: 503-718-2439 Fax: 503-598-1960 DateBy: )' Related Permit:
TIGARD Inspection Line: 503-639-4175 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified Method_` L/J�,� #:',',/ Supplemental Information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑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.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
CIAccessory building ID Multi-familyNumber of bedrooms:
❑Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11560 SW 67TH AVE New dwelling area: square feet
City/State/ZIP: TIGARD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: 1.., Project name: OFNHP Covered porch area: square feet
Cross street/directions to job site: SW BAYLOR ST./ SW 67th AVE. Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: 00200 Permit fees*are based on the value of the work performed.
Tax map/parcel#: 1S136DD 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.
INTERIOR ALTERATIONS TO THE EXISTING BUILDING TO ACCOMMODATE NEW Valuation: S 140,000
OWNER/TENANT ON FIRST AND THIRD FLOORS. Existing building area: 14,586 square feet
EXISTING SECOND FLOOR TENANTS TO REMAIN (NO WORK). NO EXTERIOR WORK. New building area: N/A square feet
❑ PROPERTY OWNER 0 TENANT Number of stories: 3
Name: Type of construction: V-B
Address: Occupancy groups:
City/State/ZIP: Existing:B
Phone:( ) Fax:( ) New: B&A-3
EI APPLICANT ►N CONTACT PERSON BUILDING PERMIT FEES*
Business name: CI DA (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: MYA PALUCH
Address: 15895 SW 72ND AVE,SUITE 200 FLS plan review fee(if applicable):
City/State/ZIP: PORTLAND,OR 97224 Total fees due upon application:
Amount received:
Phone:( 503)226.1285 Fax::( 503)226.1670
E-mail:MYAP @ CI DAI N C.CO M PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: j A v c .p COAlS l , Co, Submit two(2)sets of roof plan with connection details
6 and fire department access,along with the 2010 Oregon
Address: P.0 (,) -0-0 a 0 Solar Installation Specialty Code checklist.
City/State/ZIP: �AGi_ )m,(�S Ore-- .70 ( Lj^ Permit fee(includes plan review $180.00
/ and administrative fees):
Phone:(ctl"j ) *75 p--Z Z,/ Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.: 3_0J7 S Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: MYA PALUC Date:11/21/19 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP_COM_ tApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A R D Building Permit Review — Commercial - No Land Use
Building Permit #:
Site Address: II S G ) SW 1 ti G.I Suite/Bldg#: 200
Project Name: N r) 1)
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: J- 11 n r T C3 n 5 r G°1 in (A rc.4 �I CO
Existing Business Activity: t
Proposed Business Activity: i 1 / 1
Verify site address/suite#exists and active in permit system.
ARiver Terrace Neighborhood: ❑ Yes VNo
Zoning: T U
p Permitted Use: 0 Yes ❑ No ❑ Spec Space
pConfirm no land use required.
0 Business License:
Exists: ❑ Yes No,applicant was provided a business license application
Notes:
Approved by Planning: /V\ Date: It /Z 6
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: C / G� �o*/
Site Plans:
Building Plans: #
Building Permit#: ►' nter building permit#above.
Workflow Routing: ►: Planning ITPermit Coordinator wilding
►:Workflow Sign-off: Sign-off for Planning(include notes from p, nning review)
Route Application Documents: Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date:
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_111819.docx
Permit Coordinator Review
E 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:
C Fees Entered: Wash Co Trans Dev Tax: ❑ Yes KV /A
Tigard Trans SDC: ❑ Yes ���N/A
Parks SDC: ❑ Yes I NN/A
OK to Issue Permit icr
Approved by Permit Coordinator: Date: '`/zj
I:\Building\Forms\BldgPemntRvw_COM NoLandUse_111819.docx