Permit CITY OF TIGARD BUILDING PERMIT
:; 3 COMMUNITY DEVELOPMENT Permit#: BUP2021-00131
T I i;A RID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/12/2021
Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15875 SW 72ND AVE
Project: Northwest Integrative Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: TI remodel work to 4126 sf of existing improved space.work includes:selected demo of nonstructural walls,
suspended ceilings,doors/frames,painting,electrical distribution,lighting and plumbing.
Contractor: MATTHEW OLSON CONSTRUCTION Owner: PACIFIC REALTY ASSOCIATES LP
5320 SW DOVER LN ATTN: N PIVEN
PORTLAND, OR 97225 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-892-0066 PHONE:
FAX: 503-892-0067
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIIB Permit Fee-Additions,Alterations, 07/07/2021 $970.41
Occupancy Grp: B Occupancy Load: 28 De�molilion
12/o State Surcharge-Building 07/07/2021 $116.45
Dwelling Units: 0 Plan Review 06/15/2021 $630.77
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 07/07/2021 $274.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 07/07/2021 $388.16
Value: $82,000 Info Process/Archiving-Lg$2.00(over 07/07/2021 $10.00
11x17)
Tigard CET-Non-Residential-Admin 07/07/2021 $32.80
Floor Areas: Tigard CET-Non-Residential-AH 07/07/2021 $787.20
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,209.79
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 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: licruy p Q Permittee Signature: On/
vix,rt.��w pP
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.
Buildin Permit A lication
Commercial
IfCity of TigardDECEIVE i. -s� ,� '
r FOR OFFICE: USE ONLY
i 13125 S W Hall Blvd.,Tigard,OR 97223 Received �ft�,
Phone: 503.718.2439 Fax: D'ateB :U� /tj 2�Z/ T t�7/�, )
TIGARp Inspection Line: 503.639.417503.598.1960 Plan Revie• PecrP ,, :S�fl- -CJ�/-Qoi Internet: wwne:5 rd-or.gov CITYOF GARO DateB : �1
1 1 Date Ready/By: ill Other Permit:
BUILDING DIVISIG� No
. I,A, 45�, See ent 2l for
TYPE �r — --r t� Supplemental Information
OF WORT{
0 New construction
0 0 Addition/alteration replacement Demolition REQUIRED basDAed 1-AND 2-FAMILY of the
DWELLING
Perms fees*are based on the value of the work performed.
0 Other: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION 0 1-and 2-family dwelling work indicated on this application.
❑Accessory ®Commercial/industrial ry building Valuation: $
❑Master builder — 0 Multi-family Number of bedrooms:
❑Other
JOB SITE INFORMATION AND Number of bathrooms:
Job site address: 15875 S Waa 72 LOCATION
Avenue Total number of floors:
City/State/ZIP:Portland,OR 97224
New dwelling area:
Suite Bldg./apt.no.: square feet
Project name:NW Integrative
Covered porch area:Garage/carport area:
Cross street/directions to job site: — square feet
square feet
Deck area:
square feet
Other structure area:
Subdivision: square feet
REQUIRED DATA
Tax map/parcel no.: Lot no.: COMMERCIAL-USE CHECKLIST
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
DESCRIPTION OF WORK equipment,r indicated materials,labor,overhead,
Remodel work to 4,126 SF of existing improved sapce.Work includes selected demo Valuation:
work en this a. lication. and the profit for the
of existing nonstructural walls,suspended ceilings,doors/frames
electrical distribution,lighting, $82,000.00
painting, Existing building area: 4,126
and plumbing
® PROPERTY square feet
OWNER New building area:
dame: Pacific Realty Associates,LP. 0 TENANT 4,126 square feet
Number of stories: 1
.ddress: 15350 SW Sequoia Parkway Suite 300
iry/State/ZIP:Portland,OR 97224 Type of construction: III-B
Occupancy groups:
tone:(503)624-630U
Fax:(503)624-7755 Existing: B
ta APPLICANT
isiness names Pacific Real0 CONTACT:PERSON New: B
ty Associates,LP. BUILDING ntact name:Robert PERMIT FEES*
Bnmerot (Please re er to ee schedule
dress: 15350 SW Sequoia Parkway,Suite 300 due upon
Structural plan review fee(or deposit):
✓/State/ZIP:Portland,OR 97224 FLS plan review fee(if applicable):
ne:(503)624-6300 Total fees
nP application:
permits 1�u71624 7755
pch-usf corn Amount received:
PHOTOVOLTAIC SOLAR PANE,L SYSTEM FEES*
ail
CONTRACTOR
less name:Matthew Olson Construction Inc. Commercial and residential prescriptive installation of
roof-top mounted Photovoltaic Solar Panel System.
ass:5320 SW Dover Lane Submit two(2)sets of roof plan with connection details
hate/ZIP:Portland and fire department access,along with the 2010 Oregon
OR 97225 Solar Installation Soecia! Code c(503)892-0066 Permit fee(includes plan revieW checklist.
Fax:( )
ic.: 198796 and administrative fees : $180.00
State surcharge(12%of permit fee):iizedsignature: j� � $21.60
Total fee due upon application:
tme:Robert B `— This permit application expires if a permit is not obtained0
trot within 180 days after it has been accepted as complete.
Date: 5/18/2021 * Fee methodolo
glPermitslBUP-COM Pcrmi[A Service Board.gy set by Tri-County Building Industry
Pp•doe 02/24/2011 440-46I3T(11/02/COM/WEB)
City of Tigard
INCOMMUNITY DEVELOPMENT DEPARTMENT
T 1 c A R n Building Permit Review — Commercial - With Land Use
Building Permit #: 73UP2021- 0013 I
Site Address: 15875 SW 72nd Ave Suite/Bldg#:
Project Name: NW Integrative Medicine
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: TI-for a change of use from office to medical office
® Verify site address/suite# exists and active in permit system.
I:i River Terrace Neighborhood: ❑ Yes ® No
® Land Use Case#: MMD2021-00022
RI Plans Match Approved Land Use:
® Site Plan D Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
Q Building Height: Maximum Height Actual Height
Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
IP Business License:
Exists: ❑ Yes ❑ No,applicant was provided a business license application
x❑ Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified ] No Applied For: El Yes ❑ No, stop intake
Notes:
Approved by Planning: PlykiA
0eAmetvb Date: 6/14/2021
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
kW-Wink Permit Subrxlittal
Original Submittal Date: t)5//9/-2e2/
Site Plans: # 5
Building Plans: # ,.
Building Permit#: Mr Enter building permit# above.
Workflow Routing: [I�'Planning ❑ Engineering Permit Coordinator Ud' tuilding
Workflow Sign-off: [ Sign-off for Planning(include notes from planning review)
Route Application Documents: Lk-Building: original permit application, site plans,building plans, engineer and
beam calculations and trust deta" ,if applicable,etc.
Notes:
By Permit Technician: Date: D ///S,l1Z/
I:\Building\Forms\BldgPermitRvw_COM_W ithLandUse_111819.docx
.t7lkirleeritik keviety
O Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
O Easements (encroachments)per engineering conditions of appr.'al and plat (not typical on SDR/CUP)
0 Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes • o
Assess Water Quantity Fee in-lieu: ❑ Yes • No
LIDA Facility on lot: ❑ Ye ❑ No
❑ NOT Approved by Engineering: Date
Notes:
Approved by Engineering: Date:
Revisions (after Building Sub • ttal only) Reviewer Date
Revision 1: ❑ Approve. ❑ Not Approved
Revision 2: ❑ Appro •d ❑ Not Approved
Revision 3: ❑ App .ved 0 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:
SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ' N/A
Tigard Trans SDC: ❑ Yes N/A u
Parks SDC: ❑ Yes t,.,( N/A
OK to Issue Permit
Approved by Permit Coordinator: f U Date: CO 12 ZI 1.021
1:\Building\Forms\B1dgPermitRvw_COM_W ithLandUse_l 11819.docx