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Permit i` A .7 ® BUILDING PERMIT : CITY OF TIGARD PERMIT #: BUP2008 -00063 • L' ' COMMUNITY DEVELOPMENT DATE ISSUED: 3/6/2008 ; TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1 02 C B -00100 SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12 SUBDIVISION: CF TIGARD ELEMENTARY LOT: 041 JURISDICTION: TIG PROJECT: BROADWAY ROSE THEATRE CO Project Description: Interior demo. REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: sf N: S: E: W: OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: Owner: Contractor: TIGARD TUALATIN SCHOOL DIST. #23 ROBERT GRAY PARTNERS INC 6960 SW SANDBURG ST 12705 SW HERMAN RD TIGARD, OR 97223 TUALATIN, OR 97062 Contact #: PRI 503 - 692 - 4675 Phone: FAX 503 - 692 - 9292 Reg #: LIC 65424 • FEES Description Date Amount REQUIRED ITEMS AND REPORTS [[BUILD] Permit Fee 3/6/2008 $62.50 [TAX] 12% State Surch 3/6/2008 $7.50 Total $70.00 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 than 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 -0100. You may obtain a copy of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By �, �,. Permittee Signature: A- �^ � Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. l B uik iing Per mit Application Commercial l�"`' F OR OFFICE USE OIVLI' • City of Tigard E *:ew Received Permit No.: ��� IN . 13125 SW Hall Blvd., Tigard, OR 972 T ECEF ' 11 Phone: 503.639.4171 Fax: 503.598.1 `61 ( , Date/By: Other Permit: T 1 G A R 13 Inspection Line: 503.639.4175 M AR - 6 � � v $ Date Ready /By: Juris: See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information GITYQF Nona TYPE OF W OL!tit WING DIV!SION 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. ❑ 1- and 2- family dwelling Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: ) Z 8 5 0 5Itf, 41eibur ,4vE . New dwelling area: square feet City /State /ZIP: 7i 4Aea / or. 7 7223 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: 130:),4.124/4 Y fe051, Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CIIECKLIST Subdivision: Lot no.: .44- Zt Permit fees* are based on the value of the work performed. Tax map /passel -no.: Z 2 c-(3 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. • -- r N/4NT I re0VIAIrri ' X/ 170N Valuation: $ Z 000. Existing building area: 10/ ‘CtiSquare feet ,�/ New building area: 3 �� square feet ❑ . PROPERTY OWNER LrJ TENANT Number of stories: Name: !J. Il.erryo J' i40A1 L( Type of construction: A Address: P 0_ �}( Z 3l (254 Occupancy groups: 4 -/ City /State /ZIP: Tt 6 ,Ka OR ?725 1 Existing: ,4- 1 Phone: (503) 60 3 - 5G 6z Fax: ( %3) 6 70 a 5/ 0 New: A- j ❑ APPLICANT .. 'CCONNTACT PERSON NOTICE - - . Business name: .9 5 Y�it/J AeCtiI t��c.7 All contractors and subcontractors are required to be Contact name: ! 1 Nf ���M licensed with the Oregon Construction Contractors Board f / r under ORS 701 and may be required to be licensed in the Address: /ZC) /&/ ju A/ 41(D rACI I✓/..Cf / , S0/-1-E41.0 jurisdiction in which work is being performed. if the City /State /ZIP: rap 72 w Or, g7?:'-CZ applicant is exempt from licensing, the following reasons ( apply: Phone: ( 6 ZZ �' 5P7 Fax: : ( 4'0 3) Z 73 -- 8564 E -mail: Ti f../.4 l s rt . 60M CONTRACTOR Business name: �a 2T ( ,2rry P * / BUILDING PERMIT FEES Address: (Please refertofeeschedule) Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) ( ) FLS plan review fee (if applicable): Fax: CCB lic.: Log / Total fees due upon application: / Amount received: 76 .G0 Authorized signature // _ This permit application expires if a permit is not obtained ! " within 180 days after it has been accepted as complete. - -�, Print name: ! (14 4Y ,,R S ti Date: 3/ s * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Permits \BUP -COM PermitApp.doc 2/23/07 440- 4613T(1I/02 /COM/WEB) • Building - Division Accessibility: Barrier Reinoval Improvement Plan '.TIGAIZD 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 per -cent (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): $ 1:\ Building \Permits \BUP -COM PermitApp.doc 10/30/07 �' ` CITY ����� ����~�8���U�8� .- ` ��n� m wn�����m�� BUILDING DIVISION PERMIT ~°="��""°~� �" °"="~~"~ � BUP2008-00063 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: a/GC008 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 _w 61 I � INSPECTION WORKSHEET FOR DATE: TIME: � 12/2/2 8 : 7 PAGE: 12 SITE ADDRESS: 12860 SW GRANT AVE CLASS OF WORK: SUBDIVISION: CF llGARD[LEMEMlARy LOT #: 041 TYPE OF USE: PROJECT NAME: 13R0ADMAY ROSE ThEiVrRE CC) DESCRIPTION: � |Utw|ivv OWNER: llGARQ TUALAT N SCHOOL DIST #23, PHONE #: CONTRACTOR: ROBERT GRAY PARTNERS INC PHONE #: 503,_602.'4675 Inspection Request Scheduled For: Date: 12/2nO06 Pour Time: Code # Inspection Description Confirm # Contact # Message 289 Final inspection 078686- U1 5Oa 783-8015 N Corrections/Comments/Instructions: , , . PASS FA . PARTIAL APPROVAL �� �� CANCEL �� �� NO ACCESS AI | | FAIL FOR INSPECTION ri ADDITIONAL FEES ASSESSED I ^� mm �r � � 7� • �� Inspector: ��� � Date: L/� /_� Phone #: (503) 718' x��� � , | �^ \ `\�- ._ ` . 6 p tb CA — 00(4) Carls®n Testing 9 �� Cm ' Construction Ins pections & Related Tests Geotechnical Consulting Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 Tigard. Oregon 97281 Salem. Oregon 97301 Bend. Oregon 97708 Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 REPORT OF 4 X 8 CONCRETE TEST SPECIMENS Test Methods: ASTM C31 /C172/C192/C617/C1064/C231/C143 Date Molded: 05/12/2008 Job Number: T0806993. Permit #: BUP2008 -00063 Client: ROBERT GRAY PARTNERS INC - BOB GRAY Project: THE BROADWAY ROSE THEATRE COMPANY - REMODEL Address: 12850 SW GRANT AVENUE TIGARD OR Jurisdiction: TIGARD Contractor: ROBERT GRAY PARTNERS INC - BOB GRAY Subcontractor: Cast By: D. SUMINSKI Concrete Supplier: WILSONVILLE CONCRETE PRODUCTS Truck #: 47 Load #: 1 Ticket#: W133960 Weather: OVERCAST Test Time: 1:15 Air Temp. at Sampling Time: 57 Cylinders were cast for the following locations: • SOUTH FOOTINGS Total Concrete Placement Location: ALL FOOTINGS Strength Requirement: 3000 psi f c@ 28 Days Slump: 4.000" % Air: 1.10 Mix Number: 305001W Conc. Temp: 6 Cement Type: Max Agg: 3/4 Admix/Amt: Cubic Yards: 7 Register Number: 0083422 Lab Location: TIGARD Set Test @ Date Test Total Area Unit Type Of Tested No. Days Rec'd Date Load PSI Fracture By 7 05/13/2008 05/19/2008 47900 12.56 3810 4 MEM 28 05/13/2008 06/09/2008 61607 12.56 4910 3 MEM 28 05/13/2008 06/09/2008 61434 12.56 4890 3 MEM D Distribute attachments. Average fc @ 28 days 4 900 Please see reverse side for additional information. • Job Number: T0806993. Register Number: 008.34,22 Date Molded: 05/12/2008 Project: THE BROADWAY ROSE THEATRE COMPANY - REMODEL < I in. [25 mm] /)\\\ !Ili Type 1 Type 2 Type 3 Reasonable well- formed Well- Formed cone on one Columnar vertical cracking cones on both ends. less end, vertical cracks running through both ends. no than 1 in. [25 mm] of through caps. no well - defined well- formed cones cracking through caps cone on other end Type 4 Type 5 Type 6 Diagonal fracture with Side fractures at top or Similar to Type 5 but no cracking through bottom (occur commonly :nd of cylinder is pointed ends: tap with hammer to with unbonded caps) distinguish from Type 1 Asterisked ( *) average unit PSI test results did not meet listed acceptance criteria. Remarks: ROBERT GRAY PARTNERS INC - BOB GRAY TO: CITY OF TIGARD BUILDING DIVISION T M RIPPEY CONSULTING ENGINEERS - DOUG GANNETT SODERSTROM ARCHITECTS - TIM AYERSMAN Project Manager: STEVEN W. LEACH Reviewed By: Ty Toller On 06/13/2008 Our report pertains to the material tested only. The information contained in this report is provided subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared. No party other than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this document. Main Office Salem Office Bend Office . PO. Box 23814 4060 Hudson Ave., NE PO. Box 7918 e Tigard, Oregon 97281 Salem, OR 97301 Bend, OR 97708 Carlson Te C ��� Inc. Phone (503) 684-3460 Phone (503) 589 -1252 Phone (541) 330 -9155 ►7 9 FAX (503) 684 0954 FAX (503) 589 1309 FAX (541) 330 -9163 May 28, 2008 T0806993 Permit No. BUP2008 -00063 FIELD INSPECTION REPORT DATES COVERED: May 23, 2008 PROJECT: The Broadway Rose Theatre Company - Remodel ADDRESS: 12850 SW Grant Avenue — Tigard, OR INSPECTOR: B. Nimo 05- 23 -08: CTI representative arrived on site at 11:00 am at the request of Robert Gray with Robert Gray Partners Inc. The purpose of the visit was to observe floor slab base rock compaction for the Broadway Rose Theater. CTI representative met with Robert Gray Partners Inc. (RGP) on site. The area of the floor slab base rock being observed today was located just west of the Broadway Rose Theater & measured approximately 50' north /south by 20' east /west. At the time of CTI representative's arrival, this area had been backfilled to about 4" below finished floor elevation. According to Aaron, RGP had placed & compacted about 6" to 8" of 3 /4" minus crushed rock imported from Northfork Rock. While on site, CTI representative observed the floor slab base rock compaction. Utilizing a jumping • jack compactor, RGP re- compacted the floor slab base rock, during which CTI representative generally did not observe significant deflection under the applied load of the jumping jack, indicating the base rock had been adequately compacted. CTI representative discussed the result of observations with Aaron of Robert Gray Partners Inc. and left the site at about 11:55 am. * ** CHECK ONE BOX ONLY " "" YES NO 1. This is a preliminary inspection only. — OR — ❑ 2. The work inspected conforms to acceptance criteria listed above. If "No," the portions of the work that are non - conforming items are clearly stated above and will be added to the NCL. Remaining portions of the work, which are not preliminary in nature, are to be considered as a ❑ conforming. Our - reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSON TESTING, INC. Steven W. Leach Project Manager BN /ja cc: Robert Gray Partners Inc — Bob Gray City of Tigard Building Division T M Rippey Consulting Engineers — Doug Gannett Sodersirom Architects — Tim Aversman • 6 p zco,,c-OG �3 . Main Office Salem Office Bend Office • P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 Tigard. Oregon 97281 Salem. Oregon 97301 Bend. Oregon 97708 C arlson Testing, Inc. Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 Daily Report of Reinforced Concrete client ROBERT GRAY PARTNERS INC - BOB GRAY Project: THE BROADWAY ROSE THEATRE COMPANY - REMODEL CTI Job #: T0806993. Address: 12850 SW GRANT AVENUE TIGARD OR Jurisdiction: TIGARD CTlrepresentative R. GOUTHRO OBOA 646 was on site this date May. 29, 2008 to perform Special Inspection for: Permit BUP2007 -00433 DFS #(s) PO Number: SCOPE OF INSPECTION CONCRETE I. Checked in with superintendent or client representative. 1. Mix Design approved? © Yes n No N/A Name: AARON Company: ROBERT GRAY 2. Monitored loads arriving at job site for correct: Mix #: 355501W 2. Type of work: ® Concrete © Reinforcing Slump 4 + / -1 % Air 1. +/ - 3. Work included: ® Sampling © Inspection ? 4 X 8 CONCRETE CYLINDERS 3. Type of samples made? 4. Inspection was 'IBC' IN Continuous 0 Periodic Number of sets 1 Samples per set 4 5. Work performed: ® In the field 0 At precast shop 4. Inspected placing and consolidation of approx. 15 cubic yards of concrete. REINFORCING Yes No N/A Location of concrete placement [to include grid lines. elevations (floors) and drawing details]: 1. Reviewed previous inspection reports? X • 2. Forms clear of debris? SHOP AREA, NO GRIDS ON PLANS ON NORTH SIDE OF EXISTING BUILDING PER FOUNDATION PLAN. 3. Type, grade, size, quantity, spacing and X condition conform? 4. Verified forms will nominally result in hardened concrete of the required X cross - sectional dimensions. 5. Verified location of reinforcing steel, pipes, conduits and sleeves with respect to X minimum concrete cover. 6. Verified type and location of splices, length x After samples are tested. results will follow on break report. of contact laps, and min. diameter of bends. REPORT SUMMARY 7. Verified support & anchorage of reinforcing _ steel in the forms. X 1. Work inspected was: © Completed 0 In progress 8. Verified structural embedments in the forms x 2. Completed work inspected was in compliance with with regard to fabrication, quality and type. ® Approved plans and specifications n Shop drawings 9. Verified structrual embedments in the forms with regard to weld inspection, quantity, and x 0 RFI ❑ Design change I=1 Submittal ❑ N/A permits issued. 10. Verified cast in place anchors. x Document #(s) Dated: Description of structure inspected [to include grid lines, 3. Noncompliance item(s) were noted this date. details on elevations (floors) and drawing details]: following page(s). 0 Yes ❑ No ® N/A SAME AS PLACEMENT. 4. Noncompliance item(s) were reinspected this date, details on following page(s). fl Yes 0 No ® N/A 0 Conform Remain in progress Report(s) findings were discussed and left with AARON of ROBERT GRAY Based on the Code. approval is required from the Building Official before the SPECIAL INSPECTED items noted above can be covered. Carlson Testing has no authority to direct work of contractors or subcontractors. 0 See additional report page(s). Distribute attachments. Page 1 of Daily Report of Reinforced Concrete For: 05/29/2008 CTI Job #: T0806993. Project: THE BROADWAY ROSE THEATRE COMPANY - REMODEL Notes: In some cases more than one box may be checked for a given item on the front page. Our reports pertain to the material tested /inspected only. Information contained herein is not to be reproduced, except in full, without prior authorization from this office. If there are any further questions regarding this matter, please do not hesitate to contact this office. Respectfully submitted, CARLSO• TESTING, INC. Reviewed By: Steven W Leach Review Date: 06/05/2008 RFG /TEM ROBERT GRAY PARTNERS INC - BOB GRAY TO: CITY OF TIGARD BUILDING DIVISION T M RIPPEY CONSULTING ENGINEERS - DOUG GANNETT SODERSTROM ARCHITECTS - TIM AYERSMAN • . . 6 c) pZw —GUc 3 o C Inspections & Related Tests Carlson Testing, Int. Geotechnical Consulting Main Office Salem Office Bend Office P.O. Box 23814 4060 Hudson Ave.. NE P.O. Box 7918 Tigard. Oregon 97281 Salem. Oregon 97301 Bend, Oregon 97708 Phone (503) 684 -3460 Phone (503) 589 -1252 Phone (541) 330 -9155 Fax (503) 684 -0954 Fax (503) 589 -1309 Fax (541) 330 -9163 REPORT OF 4 X 8 CONCRETE TEST SPECIMENS Test Methods: ASTM C31 /C172/C192/C617/C1064/C231/C143 Date Molded: 05/29/2008 Job Number: T0806993. Permit #: BUP2007 -00433 Client: ROBERT GRAY PARTNERS INC — BOB GRAY Project: THE BROADWAY ROSE THEATRE COMPANY — REMODEL Address: 12850 SW GRANT AVENUE TIGARD OR Jurisdiction: TIGARD Contractor: ROBERT GRAY PARTNERS INC — BOB GRAY Subcontractor: Cast By: R. GOUTHRO Concrete Supplier: WILSONVILLE CONCRETE PRODUCTS Truck #: 57 Load #: 1 Ticket#: W134344 Weather: LIGHT RAIN Test Time: 6:45 Air Temp. at Sampling Time: 52 Cylinders were cast for the following locations: CONFER OF NOW SLAB Total Concrete Placement Location: SHOP AREA SLAB ON GRADE Strength Requirement: 3500 psi f c @ 28 Days Slump: 5.000" % Air: 1.70 Mix Number: 355501W Conc. Temp: 63 Cement Type: I —II Max Agg: 3/4 Admix/Amt: POLYHEED = 196 OZ g,5 Cubic Yards: Register Number: 0083860 Lab Location: TIGARD Set Test @ Date Test Total Area Unit Type Of Tested No. Days Rec'd Date Load PSI Fracture By I 7 06/02/2008 06/05/2008 41010 12.56 3270 3 MEM 28 06/02/2008 06/26/2008 28 06/02/2008 06/26/2008 28 06/02/2008 06/26/2008 E Distribute attachments. Average f c @ 2 8 days Please see reverse side for additional information. Job Number: T0806993. Register Number: 0083860 Date Molded: 05/29/2008 Project: THE BROADWAY ROSE THEATRE COMPANY — REMODEL < l in. [25 mm] )\\\\ Type 1 Type 2 Type 3 Reasonable well- formed Well- Formed cone on one Columnar vertical cracking cones on both ends, less end. vertical cracks running through both ends. no than 1 in. [25 mm] of through caps. no well - defined well - formed cones cracking through caps cone on other end Type 4 Type 5 Type 6 Diagonal fracture with Side fractures at top or Similar to Type 5 but no cracking through bottom (occur commonly end of cylinder is pointed ends; tap with hammer to with unbonded caps) distinguish from Type 1 Asterisked ( *) average unit PSI test results did not meet listed acceptance criteria. Remarks: • ROBERT GRAY PARTNERS INC - BOB GRAY TO: CITY OF TIGARD BUILDING DIVISION T M RIPPEY CONSULTING ENGINEERS - DOUG GANNETT SODERSTROM ARCHITECTS - TIM AYERSMAN Project Manager: STEVEN W. LEACH Reviewed By: Ty Toiler Cn 06/08/2008 Our report pertains to the material tested only. The information contained in this report is provided subject to all terms and conditions of CTI's General Conditions in effect at the time this report is prepared. No party other than those to whom CTI has distributed this report shall be entitled to use or rely upon the information contained in this document.