Permit CITY OF TIGARD BUILDING PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: BUP2021-00204
Date Issued: 9/22/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101AA09600
Jurisdiction: Tigard
Site address: 12570 SW 69TH AVE 200
Project: NW ADHA Treatment Center Subdivision: 1996-024 PARTITION PLAT Lot: 2
Project Description: TI:remove walls
Contractor: GREEN BOX MECHANICAL Owner: LG2AG HOLDINGS LLC
3265 NW 29TH AVE 12570 SW 69TH AVE
PORTLAND,OR 97210 TIGARD,OR 97223
PHONE: 503-222-0555 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 09/21/2021 $564.15
Occupancy Grp: B Occupancy Load: 38 Demolition
12%State Surcharge-Building 09/21/2021 $67.70
Dwelling Units: 0 Plan Review 09/21/2021 $366.70
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 09/21/2021 $110.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 09/21/2021 $225.66
Value: $35,000 Info Process/Archiving•Lg$2.00(over 09/21/2021 $14.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,348.21
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. Speciahy 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: No-Lhy Vain.,De,Wvgr, Permittee Signature: Ow A1',�,,,/
T'"`;„„'�,-,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 c,, _
Commercial RECEIVE FOR OFFICE USE ONLY
City Tigard II``((� ;� �j �I Received {.� �1
Date/By: V w
'r �UU 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie`'/��y
II
Phone: 503-718-2439 Fax: 503-598-1960 Date/By: I' I 2 Permit No.:6V\ ZVZ• '(X 2.Q—L
! RdatedPermit
TIGARD Inspection Line: 503-639-4175 CITY OF rIGARD Date dy,By: inns: ® See Page 2for
a Internet: www.tigard-or.gov BUILDING DIVISIO t &Method: ` Supplemental Information
TYPE OF WORK REQU D DATA:1-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
IN 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 IIICommercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12570 SW 69th Ave.-Suite 200 New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name: NW ADHD Treatment Center Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW 69th&Beveland Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel#: 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.
Valuation: $ 35,000
Interior tenant modification.Scope of work will include a removal of 3 walls to
create a new Reception&Waiting area and 1 wall to create a larger Break Existing building area: 3,797 square feet
Room. No structural work. New building area: 3,797 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: Succession Group Type of construction: V-B
Address: 12570 SW 69th Ave. Occupancy
p y groups:
City/State/ZIP: Portland, OR 97223 Existing: B
Phone:( 971) 323.1343 Fax:( ) New: B •
(I APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: CIDA (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Betty Welsh
FLS plan review fee(if applicable):
Address: 15895 SW 72nd Ave. -Suite 200
Total fees due upon application:
City/State/ZIP: Portland,OR 97224
Phone:( 503) 226.1285 ext.309 Fax: :( ) Amount received:
E-mail: bettyw@cidainc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Greenbox Mechanical Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 3265 NW 29th Ave. Solar Installation Specialty Code checklist.
City/State/ZIP: Portland,OR 97210 Permit fee(includes plan review $180.00
and administrative fees):
Phone:( 503 ) 222.0555 Fax.( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: 214076
�j Total fee due upon application: $201.60
�c.�Authorized signature: *T o „e„,( This permit application expires if a permit is not obtained
L' � "1„`-- within 180 days after it has been accepted as complete.
Print name: Betty K. Welsh Date: 08.19.21 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\BUP_COM_PetmitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
1111 M COMMUNITY DEVELOPMENT DEPARTMENT
ii ..
D Building Permit Review — Commercial - No Land L s e
TIGAR
Building Permit #: gjUp24.57,l— (DC)ZQLA
Site Address: f 2-S7D c 0 1 AVt. Suite/Bldg#:
Project Name: NVJ Ap j-} (, Trutrinair 71 2.,
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: /n (oe T
Existing Business Activity: &...-I Vl lc./j-p i1M1.W1t- c -
Propo Business Activity:
k'Jerify
site address/suite#exists and active in permit system
er Terrace Neighborhood: 0 Yes No
fel:' ted Use: Yes ❑ No ❑ Spec Space
nfirm no land use required.
Business License:
Exists: 0 Yes No, applicant was provided a business license application
Notes:
Approved by Planning: Date: Z 21
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved ❑ Not Approved
Building Permit Submittal I
Original Submittal Date: a`Z�IZ\
Site Plans: #
Building Plans: # 3
Building Permit#: g''Enter building permit#above.
Workflow Routing: Neflanning ❑-"Permit Coordinator IZ/Building
Workflow Sign-off: LI/S -off for Planning(include notes from planning 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: 61, Date: BAZ69'Zt
I:1Building\Forms\B1dgPerniltRvw_COM_NoLandUse_111819.docx
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: 0 Yes yN/A
Tigard Trans SDC: 0 Yes A N/A
Parks SDC: ❑ Yes N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date: 4 0/2J 1�
I:\Buildmg\Forms\B1dgPermitRvw_COM_NolandUse_111819.docx
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Accessibility: Barrier Removal Improvement Plan
•
•
Commercial & Multi-Family - Additions or Alterations
T[GARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
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 arc readily accessible to individuals with disabilities unless
such alterations arc 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 percent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering [1] $ 35,000
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 8,750
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: $
(t) Accessible drinkingfountains:and
$
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $
Vertical grab bars to existing restrooms on 2nd floor $ 300
Building is otherwise compliant
1:\Building\Permits\BUP_COM_PennitApp.der Rev.03/05/2019