Permit (5) CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2023-00022
Date Issued: 4/3/2023
T I(1 A R:1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9532 SW WASHINGTON SQUARE RD H11
Project: Psycho Bunny Subdivision: None Lot: None
Project Description: TI for new tenant:New partition,lighting,millwork,and finishes.
Contractor: FUTURE BUILDERS INC Owner: PPR WASHINGTON SQUARE LLC
14513 NE 87TH ST BY MACERICH RET
VANCOUVER,WA 98682 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 360-433-1851 PHONE:
FAX: 360-260-0646
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 03/21/2023 $1,407.95
Occupancy Grp: M Occupancy Load: 49 Demolition
12%State Surcharge-Building 03/21/2023 $168.95
Dwelling Units: 0 Plan Review 03/01/2023 $915.17
Stories: 0 Height: 0 ft Tenant Improvements in Existing 03/21/2023 $489.00
Bedrooms: 0 Bathrooms: 0 Development
Value: $150,000 Plan Review-Fire Life Safety 03/21/2023 $563.18
Info Process/Archiving-Lg$2.00(over 03/21/2023 $84.00
11x17)
Floor Areas: Info Process/Archiving-Sm$0.50(up to 03/21/2023 $33.00
Total Area: 0 11x17)
Accessory Struct: 0 Metro CET 03/21/2023 $180.00
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,841.25
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. hose rules are set forth in OAR
952-001-0010 through OAR 952-001-009 You ay obtain a copy of the rules or direct questions to OUNC by calling 503.;;2.1)87 or . 0.332.2344.
Issued By: tr://t-4r\ t Permittee Signature: /f
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 0 ia
Commercial FOR OFFICE USE ONLY
FEBi3
City of Tigard oater>3r: Is, 4) PermitNo.: `t,2/�* l
` N 13125 SW Hall Blvd.,Tigard,OR 97223 i f T' Plan Review Related Permit.
Phone: 503-718-2439 Fax: 503-598- Date/Bc: 3_ 1-2,3
Inspection Line: 503-639-4175 A DIVISION DateReadymy_ iuis: tRl See Page 2for
T I G A R D ({► Supplemental Information
Internet: www.tigard-or.gov Notified/Method: ,J iL
./...__ ,„, .___
_ fi
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
❑X Addition/alteration/replacement ❑Other. i equipment,materials,labor,overhead,and the profit for the
a - "C"" work indicated on this application.
,I CATEGORY OF CONSTRUCTION
_ 'Valuation: $
' ❑1-and 2-family dwelling ®Commercial/industrial
—- - Number of bedrooms:
�❑Accessory building ❑Multi-family --- --- ,..,.
❑Master builder ❑Other. t Number of bathrooms
JOB SITE INFORMATION AND LOCATION i Total number of floors:
Job site address:9532 SW Washington Square Rd New dwelling area square feet
City/State/ZIP: Portland, OR 97223 Garage/carport area: square feet
I Suite/bldg./apt.#: Suite#H11 [Project name:Psycho Bunny Washington Square-Portlan Covered porch area: square feet
t Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Yeilit; �_.,� �,:,:
s REQUIRED DATA:COMMERCIAL-USE CHECKLIST
tr., Subdivision: Lot#: 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
d. t.1 DESCRIPTION OF WORK work indicated on this application.
'�, ARCHITECTURE:NEW INTERIOR TENANT FIT-OUT NEW PARTITION,FINISHES,LIGHTING,MILLWORK AND Valuation: $
i . 1E
t q, ELECTRICAL NEW LIGHTING POWER AND DATA SUPPLY FOR MILLWORK AND BOH. Existing building area:
New building area 1447 square feet
T MECHANICAL NEW HVAC UNIT,DUCTWORK AND DISTRIBUTION SYSTEM - .,.»-..
T Ua 1 TZTI AN'C"'IF:TV''C IO ..,.._
i, ` Ilk STRUCTURE:MINOR STRUCTRUCTURAL INTERVENTION square feet
0;•` ® PROPERTY OWNER ❑ TENANT Number of stories:
Name: ! Type of construction: V-B
Macerich (Conatct: ChalieSirokman) _ _ .... „,
Address: 401 Willshire Blvd Suite 700 Occupancy groups: Mercantile
city/State/ZIP: Santa Monica, CA 90401 Existing
Phone:((602)953-6377 Fax:( ) New Psycho Bunny Retail Store
( APPLICANT Ni CONTACT PERSON 1 BUILDING PERMIT FEES*
,,, (Please tore,+afeeschedale#
Business name: Structural plan review fee(or deposit):
..._..in.
Contact name: - "
Samantha OlendOrff E FIS plan review fee(if applicable):
.;
Address: 13400 Riverside Dr#202 y
�� Total fees due upon application:
City/State/ZIP: Sherman Oaks, CA 91423
c �w r Amount received:
6 Phone:( 415}663 2112 ext. 1630 Fax :( )
�- w-- ° "" PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES**
E-mart: Samantha Olendorif ¢ �t- ro y
, ,.... _,...._ Commercial and residential prescriptive installation of x
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Business name: Pe-- �� Submit two p(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: "1 J) Y1 e" i c E-j Solar Installation S tecia1. Code checklist,
City/State/ZIP: CtJ� �'J`,,Q Peruutfee(includesplanreview $18000
f,�( `Y and administrative fees':
Phone:( L$ 3.3 _I: - 5 I Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lie.: !,,(j 3 ,„i/ i/,A Total fee due upon application: $20].60
Authorized signature: This permit application expires if a permit is not obtained
`�, --" tom within 180 days after it has been accepted as complete.
Print name: Samantha Olendorff 1e: '2/14 _2 3 * Fee methodology set by Tri-County Building Industry
...._. Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doe Rev.04/21/20I4 440-4613T(11/02/COM/WEB)
City of Tigard
INN COMMUNITY DEVELOPMENT DEPARTMENT
I
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: ,e4„, ?J -o ;
Site Address: CIC3)_ S S1LA0-01 . 129. Suite/Bldg#:
Project Name: c-1 C1-1-2 t.)U\-)y
(Name of commercial businest occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: .1 , L. , r Pre iC(-. 1I^1 w- ralAi2nrc ii,16,Y
Existing Business Activity: $A 1.e..( -- O(Zi�" Sz, .ert I L'
Proposed Business Activity: S) -j S " oco an j L
Verify site address/suite# exists and active in permit syste .
❑ River Terrace Neighborhood: ❑ Yes gr No
VZoning: M ()) ,
/Permitted Use: A Yes ❑ No ❑ Spec Space
Dr-onfirm no land use required.
Business License:
Exists: ❑ Yes VNo,applicant was provided a business license application
Notes:
Approved by Planning: 47/-te -- Date: /'/
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: 11'5 1,3
Site Plans: #
Building Plans: #
Building Permit#: rater building permit#above. .,�13u
Workflow Routing: grnit Coordinator LI ildmg
Workflow Sign-off: A -.gn-off for Planning(include notes from planning review)
Route Application Documents: Q--B i1i g: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable, etc.
Notes:
By Permit Technician: C ate: ,/,ty/23
I:\Building\Forms\BldgPermitRvw_COM NoLandUse 09072022.docx
Permit Coordinator Review
IA-Conditions "Met"prior to issuance of permit
❑ Approved,NOT Released: Date:
❑ ENG Revisions Required: Date:
Notes:
❑ SDC Exemption ❑ Applied for ❑ Received /Does not apply
Fees Entered: Wash Co Trans Dev Tax: ❑ Yes /N/A ❑ Deferred ff'.F'
Tigard Trans SDC: ❑ Yes /N/A El Deferred VV .'30
Parks SDC: El Yes /N/A El Deferred
LIDA Fee: ❑ Yes N/A
OK to Issue/Approved by Permit Coordinator: Date: 4 f2o2' '
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved El Not Approved
Revision 2: El Approved El Not Approved
Revision 3: El Approved ❑ Not Approved
I:\Building\Fonns\B1dgPermitRvw_COM NoLandUse_08162022.docx
wY BAN
City of Portland, Oregon R EC E IV
an,Commissioner
Qo oEA
wrrn��� Rebecca Esau,Director
o/ . %ems p ����'�'� Bureau of Development Services FEB 9 5 CU� hone:(503)823-5996
rr * ;iiL:i-'�' - i OF TIGARD Fax:(503)823-7425
7777
Inspection ServicesFacility Permit Pr NG Di!/isio '(503)823-6868
185, FROM CONCEPT TO CONSTRUCTION www.portland.gov/bds
Structural Special Inspection and Observation Program Checksheet
The registered design professional in responsible charge shall prepare and submit a special inspection and structural observation
program in accordance with OSCC 107.1 and 1704,and confirm that the special inspection and structural observations noted below are
indicated on the drawings.
-Please Note that separate Soils and Life Safety Inspection Checksheets may also be required-
Instructions — Parts D and E of this Checksheet must be fully completed by the Owner.
(or Architect or Engineer acting as the owner's agent) in order to obtain your permit.
When complete, return this form to BDS Permitting Services. You may return it by email to
fppspecialinspectionschecksheets@portlandoregon.gov
Application# Date: JAN 25, 2023
Project Name: Psycho Bunny
Site Address: 9532 SW Washington Square, Suite H11
Applicant Phone#
Engineer of Record (Firm) Nicholas Burnam (Eclipse Engineering) Phone# 541-389-9659
The following special inspections and structural observations shall be performed according to the State Building Code and City of
Portland Special Inspection Program Administrative Rules unless a program of inspections is submitted by the Engineer of Record
and approved by Bureau of Development Services.
A. REQUIRED SPECIAL INSPECTIONS FOR ALL BUILDING TYPES
nSteel Construction n Concrete Construction Anchors—Adhesive Wood Construction
nCurtainwall n Prestressed Concrete n Anchors—Cast-in-place n Masonry
Structural Silicone Glazing n Shotcrete n Anchors—Expansion/Screw n Cold Formed Steel Framing
B. REQUIRED SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE (OSSC 1705.12)
nSeismic Force Resist. System n Storage Racks 0 Access Floors n Suspended Ceilings
nMechanical Components n Electrical Components n Cladding n Veneer
nNonbearing Walls n Seismic Isolation System
C. STRUCTURAL OBSERVATION
W n Required (The stages of construction at which structural observation is to occur shall be indicated on the drawings.)
0.5 D. APPROVED SPECIAL INSPECTOR OR INSPECTION AGENCY(To be completed by the applicant.)
0 Indicate the City approved special inspector or special inspection agency to perform the required special
cn
inspections noted in parts A. and B. above:
CC
Qa ACS(503)443-3799 Q FEI Testing(541)757-4698 PSI (503)289-1778
❑ Carlson Testing (503)684-3460 KPFF SIG (503)227-3251 Terracon(503)659-3281
❑ Clair Company(541)758-1302 Materials Testing/Insp(208)376-4748 ❑ Other:
a. ❑ Columbia West Eng (360)823-2900 ❑ Northwest Geotech (503)682-1880 Q
2
0 E. To be completed by the applicant.
By completing Part E the project owner(or the Architect or Engineer acting as the Owner's Agent)hereby agrees to
employ the special inspector or inspection agency and/or engineer of record for the above noted special inspections
Z and/or structural observations. (Contractors are NOT authorized to agree for the Owner.)
UThe project owner shall provide a copy of this checksheet,to the s cial inspections agency and engineer of record.
a Print Name Nicholas S. Burnam, PE i1ja(,41-r 7- Date JAN 25, 2023
(Project Owner or the Architect or Engineer acting as the ner's Agent)
Firm Eclipse Engineering, PC Phone 541-389-9659