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Permit v CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2008 -00380 ° COMMUNITY DEVELOPMENT DATE ISSUED: 11/26/2008 , TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S135BD-00300 SITE ADDRESS: 09735 SW SHADY LN 101 ZONING: C -G • SUBDIVISION: DRS FAMILY CLINIC LOT: JURISDICTION: TIG PROJECT: DR SCHWARTZ Project Description: TI 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: 5N sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: 3 HT: ft GARAGE: sf OCCU SEP. RATED: BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 22,000.00 Owner: Contractor: HAZEL INTERNATIONAL, INC AND FX REPAIR DIVISION HIGASHIYAMA HIGHLANDS CO, LTD 2950 NW 29TH AVE BY NORRIS + STEVENS REALTORS PORTLAND, OR 97210 PORTLAND, OR 97204 Phone: Contact #: PRI 503 - 542 - 4442 FAX 503 - 542 -4441 Reg #: LIC 100757 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 11/25/200E $205.50 [TAX] 12% State Surch 11/25/200E $24.66 [BUPPLN] PIn Rv 111251200E $133.58 [FLS] FLS PIn Rv 11/25/200E $82.20 Total $445.94 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 e - • , • • • • - rted within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon la , • -quires you to follow the rules • • : • b the O regon Utility Notification Center. Those rules are set forth in OAR 952 001 0010• gh OAR 952 001 0100 Yo :y obtain ....y of thes- es • ect qu-stions to OUNC by calling 503.246.6699 or 1.800.332.2 Issue • ' =y: / _/ ��` _/ Per mittee Signature: �- N • 1 i -� - - Call 503.639.4175 by 7:00 a.m. for an inspecti • n that usiness day. This permit card shall be kept in a conspicuous place on the jo • site til completion of the project. Approved plans are required on the job site at the t , e o each inspection. Huildin! Permit Application Eh1. e-aDor , c ) cI% Commercial Tenant Improv= .�i`leEWJED FOR OFI I(�L U 1_'. ON I �( /� II Citty of Tigard Received E p" 4., rcrmitNo.: l r �!• 1. UV 13125 SW Hall Blvd., Tigard. OR 97223 v 2 5 2008 pl. Rev �3 ="iIP Phone; 503.639.4171 Fax: 503.598.1960 ' 0 DateiB dilWA,. �' ii � her Permit. 2 for r , n i ; Inspection Line: 503,639,4175 C]BUtI ,� GFT eAnN hoa // J � "I l Ci Supplem Information ln�rnct: www.tigard•or.gov GDN (� DI ,! • TYPE OF .W ORK REQUIRED DATA0.- AND 2-FAMILY DWELLING • ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. • ( ddition/altetation/replaccmcnt ❑ Other: equipment. the value (rounded to the nearest dollar) of ail equipment. materials, labor, overhead, and the profit for the CATEGORY OF CONSIRUCI'ION. work indicated on this application. 01- and 2- family dwelling ommerciallindusttial Valuation: $ 0 Accessory building ❑ Multi- family Number of bedrooms: 0 Master builder ❑ Other: Number of bathrooms: ' JOB SITE INFORMATION •• AND LOCATION Total number of floors: Job site address: cl 735- s' Sli), a4t ,, , L,vt, I New dwelling area: square feet City /State/ZIP: -r i e n r d , 0 i 9 j. f a?3 Garage/carport area: square feet Suite/bldg.apt_ no.: , j name: me: r , r ,- Coveted porch area: square feet Cross street/directions to job site: Deck area: square feet LA .Al ' ;i 1 et- 5'C_.J 61' r ' { r' ,, , ,,: ti f r^ r ,*' . Other structure area: square feet Cd c,- . REQUIRED DA COMMERCiAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax m / indicate the value (rounded to the nearest dollar) of all ap parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK ' work indicated on this application_ f! ' Valuation: $ Aa 000 t ` ')' Existing building area: square feet 1.14•ir d�.l.'.'C \• .Jr Ls !l 'u'�`�efte f t,�Qt - si a // New building area: • square feet Q. PROPERTY OWNER i IENAr4T : Number of stories: Name: 1 f , --E.; .�, J e. It o i 1. (4 .14 Typc of construction: Address: 17 53 �.) n , Li , 0 1 o 0 Occupancy groups: City/State/ZIP: -- i 1 AA r 0( . U l e 9 t` / ? c 3 Existing: Phone: ($) 1a 9 - ` O Fax: (6 ) t): - 4/0 New: . • APPLICANT • ❑ CONTACT PERSON. • NOTICE . Business name: F X T r. 4- Re wt d, G Ka I a All contractors and subcontractors am required to he f V licensed with the Oregon Construction Contractors Board Contact name: ` / 77? f r v r r• / K under ORS 701 and may be required to be licensed in the Address: r; 9 , 0 r w a r et owe !, . jurisdiction in which work is being performed. If the City/State/ZIP: 1 f t L Q -� m Q 7 a�/ () applicant is exempt from licensing, the following reasons apply: Phone: ( )rtr' gig t/k I Fax: : (rDS) ,( ` 414/97 Email: r 0" OD F x r,%a i t , a o Yv\,, ■ • CoNTRAcroR . 1 Business name: i f Pp 12 %D t Of e?‘ O tl/ / . . BUILDING PERMIT FEES* Address: _ C/ 4 ,4 1 I e I, Mar refer infer schedule) City/State/ZIP: Structural plan review fee (or deposit): ..C1- /4 t QAS{S/}GT(ot k / t-.?---• FLS plan review fee (if applicable): Phone: ( ) Fax: ( ) CCB Iic.: (7( 7 7 Total foes �:;•'• •p tcation: , Authorized signature: ` or...,,,,, f � y � ^ Amount roccived: ' y�5 S ' 4 This permit • ..'cation expires Ifs permit Is , :. nod I Print name: - • within 180 days n ; , .. ; , I as complete, / �p A. V Date: / � - [' • Fee methodology set by Tri- County Building Indu ; 0g Service Board. _ n r I2 ' /( 1:1Building1PcrmitsNBUP Ti- PermitApp.doe 12/27/06 440.4613T(11 /02/COM/WEB) FP- % NOV -20 -2008 THU 08:18 TEL:1 NAME: P. 1 y Ill! ■ 4 Building Division Plan Submittal Requirements I i ( ■ '\ D Commercial & Multi- Family - New, Additions or Alterations L SITE PLAN (fully dimensional, drawn to scale) 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 04ll be incorporated into tb& 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. 4. EXTRA SET OF THE FOLLOWING: A. Two (2) copies of site plan to include vicinity map. • B. One (1) copy of erosion control plan with details. C. Fire Department Building Survey, and full set of architecture drawings. I \ Building \Per tABUP- TI- PccmitApp.dot 03/23/n6 NOV -20 -2008 THU 08:19 TEL:1 NAME: P. 3 q Building Division Accessibility: Barrier Removal Improvement Plan • REQUIREMENT: OREGON REVISED STATUTE (ORS) 4472.41. (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 restroorn: $ (c) 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 TI PcnnitApp.doc 03/23/06 N0V -20 -2008 THU 08:19 TEL:1 NAME: P. 4 a Building Division Plan Submittal Requirement Matrix • Commercial & Multi - Family - New, Additions or ,Alterations • of T a of Submittal ... yp . • • . # PL s {Includes new; additions and alterations.) ' ; :Requited at., :. .. • Submittal • Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 2 ** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 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 set of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over -the- counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i: Binding \Pcxnits\DUP- fl-PcrmitApp,doc 03/23/06 NOV-20-2008 THU 08:19 TEL:1 NAME: P. 2 71 . Building Division Over- The - Counter (OTC) Building Permit T I G A R D Check List Description of Project: ( GENERAL INFORMATION Class of Work:* � � Floor Areas (sq. ft.): Exterior Wall Construction: Type of Use:* ,Iii First floor: N: S: Type of Construction: .513 Second floor: E: W: Occupancy Group: F Third floor: Openings Protected Y /N ?: Occupancy Load: Total sq ft.: N: S: Stories: Note: Combine total floor area for E: E: H all floors above third floor and Roof Construction: Floor Load: add to the third floor s . ft. Fire Retardant: Basement: Basement: Area Separation Rated: Mezzanine: Garage: Occu. Separation Rated: REQUIRED ITEMS Fire sprinkler: -u )' Handicap access: Smoke detector: Protected corridors: • Fire alarm: 1r) Parking spaces ( #): Notes: Total Valuation: $ A l INSPECTIONS ' FEES DUE Footing /foundation Firewall $ (C • , Fee Post /beam structural Smoke detector $ r+ State Surcharge Shear wall Misc. inspection $ /,.5 3....sc Plan Review Fee Masonry Approach /sidewalk $ tA. Ao FLS Plan Review Fee Framing $ Additional Permit Fee Insulation Sprinkler rough -in $ Additional Plan Review Fee Gyp board Fire alarm $ Metro Construction Excise Tax Suspended ceiling Sprinkler final $ School Construction Excise Tax Final inspection $ Misc. Fee $ Hourly Rate Fee $ Hourly Rate State Surcharge $ Other: $ 775 ' 9 r Total Fees Due *OPTIONS: TYPE OF USE: COM = commercial; CMS = commercial manufactured structure. CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo; FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies); REP = repair. 1: \ Building \ Forms \OTC - BUP.doc 08/19/08 CITY OF TIGARD • BUILDING DIVISION PERMIT #: Bt1P2008- 00380 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11t26/2008 .Phone: (503) 639 -4171 " i, ti Inspection Requests (24 Hrs.): (503) 639 -4175 -:W 1.— INSPECTION WORKSHEET FOR DATE: 12/30008 TIME: 7:00AM PAGE: 15 SITE ADDRESS: 09735 SW SHADY Lhi 101 CLASS OF WORK: SUBDIVISION: [)RS FAMILY CLINIC LOT #: TYPE OF USE: PROJECT NAME: ix SCHWARTZ DESCRIPTION: - I - I OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #: CONTRACTOR: FX REPAIR DIVISION PHONE #: 503 - 5424442 Inspection Request Scheduled For: Date: 12/3/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 285 Drywall nailing 079735-01 503 -542 -4442 N Corrections /Comments /Instructions: 411 :„ / . RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS is FAIL �/, CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Date: Z O Ph one #: (503) 718- �/ Inspector: ( ) Z. CITY OF TIGARD ... BUILDING DIVISION ., PERMIT #: BUP200t3- 003f30. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1117e'2008 Phone: (503) 639 -4171 , e Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 12/1/20013 TIME: 7:00AM PAGE: 27 SITE ADDRESS: 0976 SW SHADY LN 101 CLASS OF WORK: SUBDIVISION: .DRS FAMILY CLINIC LOT #: TYPE OF USE: PROJECT NAME: DID SCHWARTZ DESCRIPTION: -I1 OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #: CONTRACTOR: FX REPAIR DIVISION PHONE #: 503-542-4442 Inspection Request Scheduled For: Date: 12/1/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message X75 Framing 078602-01 503-619-1206 N Corrections /Comments /Instructions: Jig.. L =� G* I-a U - Al.1 P SS ARTIAL APPROVAL ❑ CANCEL El NO ACCESS ❑ FAIL i ffrg- / •ALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED Inspector: _ J∎ Date /2— / Phone #: (503) 718- Z_Cl-/K N.