Permit CITY OF TIGARD BUILDING PERMIT
i • COMMUNITY DEVELOPMENT Permit#: BUP2022-00256
Date Issued: 12/1/2022
T I C A 12 D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101AA07600
Jurisdiction: Tigard
Site address: 12540 SW 68TH AVE
Project: Connect Physical Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: Tenant improvement with no exterior work.
Contractor: BNK CONSTRUCTION INC Owner: CONNECT PHYSICAL THERAPY
45 82ND DR, SUITE 53B 12540 SW 68TH AVE
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503-808-0729 PHONE:
FAX: 503-557-1085
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 12/01/2022 $1,679.75
Occupancy Grp: B Occupancy Load: 26 Demolition
12%State Surcharge-Building 12/01/2022 $201.57
Dwelling Units: 0 Plan Review 10/18/2022 $1,091.84
Stories: 0 Height: 0 ft DC Provision Review, COM TI-Ping 12/01/2022 $434.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 12/01/2022 $671.90
Value: $195,000 Info Process/Archiving-Lg$2.00(over 12/01/2022 $12.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4,091.06
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 OAS 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.
A 1
Issued By: '- 2 2 . !1,>' - I ( / Permittee Signature:
-1. `\..K Lam,Li
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 RECEIVE FOR OFFICE USE ONLY
City of Tigard OCT 1.13202? Received /0//342 "iVG?�- .2
1111 u 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
g Plan Review
Phone: 503-718-2439 Fax: 503-598-1960 CITY OF TIGARD Date/By: JO'3. Related Permit:
'1 See Page 2 for
'1GARD Internet:Inspect www.tigard or gov n Line: 75 BUILDING DIVISION Notified/Method: \I II �� Tar£ ®pplement al Information
,yywll I`wt-Wtc.At`1 0c il( i -
TYPE OF WORK REQUIRED 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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
CI I-and 2-family dwelling I ]Commercial/industrialValuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12540 SW 68TH AVE, New dwelling area: square feet
City/State/ZIP: TIGARD,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.#: Project name:CONNECT PHYSICAL THERAPY Covered porch area: square feet
Cross street/directions to job Site: SW BEVELAND ST/SW 68TH AVE Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#:2S101AA07600 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: 195,000.00 $
THE PROPOSED WORK UNDER THIS PERMIT INCLUDES A NEW TENANT IMPROVEMENT.NO
EXTERIOR WORK. Existing building area:3,891 square feet
New building area: N/A square feet
® PROPERTY OWNER 0 TENANT Number of stories: 1
Name: CONNECT PHYSICAL THERAPY Type of construction:VB
Address:12540 SW 68TH AVE, Occupancy groups:B
City/State/ZIP:TIGARD,OR 97223 Existing: 3,891
Phone:( ) Fax:( )
New: N/A
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: CIDA.INC
(Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Kamelia Kargar
FLS plan review fee(if applicable):
Address: 15895 SW 72nd AVE,
Total fees due upon application:
City/State/ZIP:PORTLAND,OR 97224
Phone:( 503)226-1285 Fax:: ( 503)226-1670 Amount received:
E-mail: KAMELIAK@CIDAINC.COM PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: BnK CONSTRUCTION,INC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4582ND DR#53B Solar Installation Specialty Code checklist.
City/State/ZIP: GLADSTONE,OR 97027 Permit fee(includes plan review $180.00
and administrative fees):
Phone:( 503)80e-0729 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.:107555
Total fee due upon application: $201.60
4,._.
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Kamelia Kargar Date: 10/12/2022 * Fee methodology set by Tri-County Building Industry
Service Board.
1:ABuilding\Permits,BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Accessibility: Barrier Removal Improvement Plan
Commercial & Multi-Family - Additions or Alterations
TIGARD 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 are readily accessible to individuals with disabilities unless
such alterations are 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] $
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
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:
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms:
TOTAL(shall equal line [2] of Valuation Computation): $
I:\Bullding\Permits\BUP_COM_PermitApp.doc Rev.03/05/2019
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Plan Submittal Requirements
Commercial & Multi-Family - New, Additions or Alterations
TIGARD
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
1. SITE PLAN (3) copies - fully dimensional, drawn to scale and labeled with:
A. ❑ map&tax lot# ❑ project name ❑ site address ❑ suite number
❑ zoning ❑ applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit - based on valuation of project.
I:\Building\Permits\BUP_COM_PcrmitApp.doc Rev.03/05/2019
.t.
• City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
ill " Plan Submittal Requirements Matrix
Commercial & Multi-Family - New, Additions or Alterations
rtGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan is required showing location and square footage
of all buildings to be demolished,erosion control plan and
tree protection,if applicable)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Solar Photovoltaic 2
(Requires check list for prescriptive installation. If not
prescriptive installation,engineering is required.)
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington
County, and Tualatin Valley Fire & Rescue), if applicable.
I:\Building\Pernvts\BUP_COM_PermitApp.doc Rev,03/05/2019
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: jk(g/�Z - c la1111100
Site Address: I25 `k SUJ cot-.6" A �' Suite/Bl.
Project Name: UNo `r'tfi'y1cAL
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: '--1--='y.
Existing Business Activity: 6F/2l.-0'L-
Propo Business Activity: MeQ%C. - bf -e
Verify site address/suite# exists and active in permit syste
ver Terrace Neighborhood: ❑ Yes No
otung: �M u
7ermitted Use:
Yes ❑ No ❑ Spec Space
cate Floodplain: ❑ Yes ❑ To
Su emental Floodplain Form Required: ❑ Yes,applicant was notified ❑ No
eceived: ❑ Yes ❑ No
ir�rl
Kxisiness
License:sts: ❑ Yes o,applicant was provided a business license application
Not •
e
Approved by Planning: Date: _ /O/PAZ
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: /0 7i, /,ZZ_
Site Plans: # 7
Building Plans: #
Building Permit#: -B Enter building pomit# above.
Workflow Routing: $Planning Permit Coordinator f7.3 1 ilding
Workflow Sign-off: E—Sign-off for Planning(include notes from planning review)
Route Application Documents: 2-Building: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: 41 ,/n Date: 10113 711
I:\Building\Forms\B1dgPennitRvw_COM_NoLandUse_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of permit
• ❑ Approved,NOT Released: 7 Date:
❑ ENG Revisions Required: Date:
Notes:
❑ SDC Exemption ❑ Applied for , ❑ Received ❑ Does not apply
El Fees Entered: Wash Co Trans Dev Tax ❑ Yes ❑ N/A ❑ Deferred
Tigard Trans SDC: ' ❑ Yes ❑ N/A CI Deferred
Parks SDC: / El Yes ❑ N/A ❑ Deferred
LIDA Fee i/ ❑ Yes ❑ N/A
❑ OK to Issue/Approved by : -rmit Coordinator: Date:
Revisions (after Building S *mittal only) Reviewer: Date:
Revision 1: ❑ % ■proved ❑ Not Approved
Revision 2: IN Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\B1dgPermitRvw_COM NoLandUse_08162022.docx
RECEIVED
OCT 13 2022
CITY OF TIGAHI3
Ey! City of Tigard BUILDING DIVISIOI"'
Address and Commercial Suite Application
Addresses and suite numbers are assigned by the City of Tigard.Once a new address/suite is issued,the city
notifies 911, LISPS,Washington County and various utility providers.This does not change any account information
or replace a "change of address"form.
Directions To Submit Form
1 Fill in form ► Via email:OscarC@tigard-or.gov
► Attach Site Map or Suite Layout Map (see below) 1 In person:Permit Center Building Counter
► Fees will be charged when new address is assigned (13125 SF Ilull BhiL,Tisual,Olt)
► Per address$50 Oscar Contreras,Public Works Department
► Per suite$50 OscarC@tigard-or.gov
► Suite or address to be retired—no charge 503-718-2687
► Re-activating suites in our system—no charge
REQUIRED
Attach Site Map or Suite Layout Map
For Site Maps—show location of building on lot,front entrance and location of driveway along street.
► For Suite Maps—show the locations of current active suites,new suites and suites to be retired.
Site Information I
Parcel Number or Current Address: Q 2. 90 S IA6 84 fie. I Ti d , o 2 41 1 `3
❑ Residential Property—08— ►- Commercial Property Number of New Addresses:
Building Name(if applicable): Con V e_i 1 ()kt c...t IS 1
Is this property currently in the land use process (i.e.partition,site development review)? 0 Yes ❑ No
7kAt Wowtd ,C,kR 4 JSL Cua #- A
Contact Information
*Please sketch the building layout with address
Property Management Company (if applicable): locations:
Contact Person:
Phone: Email:
IMCFPnm vxm..mdaa.ssnncicaion Fo. l'or,,,on'h,Ie,w,a/ion.p/eis rLri /1 wu:JO(JIYI-0f..g0,'